Distinct inflammatory gene expression in extraocular muscle and fat from patients with Graves' orbitopathy.

OBJECTIVE: This study sought to compare patients with thyroid eye disease (TED) and normal controls with respect to the expression of the NR3C1, CHUK, IKBKB, FOS, NFKB and HSD11B1 genes in orbital fat (OF) and extraocular muscle (EOM). DESIGN AND METHODS: A prospective study design was used to evaluate 34 TED patients and 38 healthy controls. OF was harvested from 33 TED patients and 27 controls. EOM biopsies were obtained from 32 TED patients and 18 controls. Samples were examined by real-time PCR and evaluated using appropriate statistical analyses with a significance cut-off of P < 0.05. RESULTS: NR3C1 mRNA levels were higher in TED EOM (median 213 (96-376)) than those in control EOM (78 (34-138)) (P < 0.001), and NFKB expression was elevated in TED muscle (223 (31-520)) relative to that in control muscle (8 (6-31)) (P < 0.001). HSD11B1 expression was higher in TED EOM (0.78 (0.47-2.01)) than that in control EOM (0.22 (0.09-0.51)) (P < 0.001). Levels of CHUK, IKBKB, and FOS were higher in TED EOM (115 (20-223), 111 (54-299) and 0.11 (0.03-0.19), respectively) than those in control EOM (5.8 (2-13), 21 (5-52) and 0.05 (0.001-0.03) respectively) (P < 0.001). CONCLUSION: Tissues involved in GO exhibited different mRNA levels of NR3C1, CHUK, IKBKB, FOS, NFKB and HSD11B1. Gene expression in OF was similar for TED patients and controls. CHUK, IKBKB, FOS, NFKB, and HSD11B1 mRNA levels were higher in TED EOM than those in control EOM. NFKB was disproportionally elevated compared with NR3C1; this finding was indicative of a local proinflammatory profile.

Treatment of eyelid xanthelasma with 70% trichloroacetic acid.

PURPOSE: To analyze the results of treatment of eyelid xanthelasma (EX) with 70% trichloroacetic acid (TCA) with regard to efficacy, cosmetic appearance, patient satisfaction, and recurrence rate. METHODS: Twenty-four patients with EX of up to one third of the affected palpebral area were treated with 70% TCA. All patients were photographed at the start of treatment and 3 months after the last application. The recurrence rate was analyzed at the end of 6 months of treatment. RESULTS: The average number of applications of 70% TCA until the xanthelasma resolved was 1.5. Eleven patients (45.8%) had an excellent result, 8 (33.3%) a good result, and 5 (20.8%) had a satisfactory result. The most common complication was hypopigmentation (33.3%). All patients reported an improved final cosmetic result. Six patients (25%) treated with 70% TCA had a recurrence 6 months after treatment. CONCLUSIONS: The results of prospective treatment of 24 patients with EX with 70% TCA indicated that this is a simple and effective method, achieves a satisfactory cosmetic result, has an acceptable recurrence rate, and high patient satisfaction.

[Congenital epiphora in patients with Down syndrome]. / Epífora congênita nos pacientes com síndrome de Down.

PURPOSE: To describe the causes of congenital epiphora in patients with Down syndrome. METHODS: Retrospective study of 695 patients with congenital epiphora, of the Lacrimal Sector of the Department of Ophthalmology, São Paulo "Santa Casa", Brazil, between October 1998 and July 2005. This study analyzed: the main symptom of continuous epiphora or mucous discharge, which affected one or both eyes, since birth. Subjects were separated in to two groups: group A, with 30 patients with Down syndrome and group B, with 665 control patients. The lacrimal evaluation was performed by the throw irrigation test after general anesthesia. RESULTS: Both groups were statistically similar regarding age (p=0.07), sex (p=0.63) and race (p=0.68). Bilateral symptoms were more frequent in group A (p=0.0008). Anatomic obstruction of the lacrimal canal was present in 32.73% of group A and in 85.51% of group B (p<0.0001). CONCLUSIONS: The most frequent cause of congenital epiphora in Down syndrome is due to functional block of the lacrimal pump. Eyelid muscle hypotony and eyelid changes, common in Down syndrome, is the main hypothesis of lacrimal dysfunction, but further studies will be necessary for confirmation.

Schwannoma maligno de órbita / Schwannoma malignant orbital

Relatou-se um caso de tumor maligno de nervo periférico (schwannoma) na órbita e revisou-se a literatura sobre essa rara lesäo