Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.567
Filtrar
2.
J Neuroophthalmol ; 42(1): 26-34, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35500236

RESUMO

BACKGROUND: Teprotumumab, a monoclonal antibody that blocks the insulin-like growth factor-1 receptor, has recently been approved by the US Food and Drug Administration (FDA) for the treatment of thyroid eye disease (TED). Since its approval, aside from data on the safety and clinical efficacy of teprotumumab from Phase-2 and Phase-3 trials, only a handful of reports have been published regarding its use in the wider population. In this review, we briefly describe the mechanism of action of teprotumumab and review the literature to provide an overview of published clinical experience. This information was used to provide recommendations for patient selection, management of patient expectations, infusion details and site options, tips to optimize the authorization process, and how to monitor and mitigate side effects. EVIDENCE ACQUISITION: A systemic review of the literature was performed regarding teprotumumab, focusing on its mechanisms of action and published reports on its use on patients with TED. A review of Embase, Medline (PubMed), Web of Science, and Google Scholar was conducted. RESULTS: Clinical experience following the approval of teprotumumab has confirmed its efficacy in reducing inflammation and proptosis in patients with acute TED (<2 years). The reduction in proptosis occurs due to a reduction in orbital fat and muscle volume. Furthermore, there is evidence for its use in patients with compressive optic neuropathy. There are also reports that show its efficacy in reducing proptosis, inflammation, and diplopia in patients with chronic TED (>2 years). Teprotumumab was associated with side effects, such as muscle spasm, hearing loss, and hyperglycemia. To date, 2 case reports have shown a possible association with flares of inflammatory bowel disease. CONCLUSIONS: Teprotumumab is a powerful therapeutic option for the treatment of TED. Clinical experience following FDA approval has demonstrated efficacy in treating patients with acute and chronic TED. It is the only therapeutic option that has been shown to reduce orbital soft tissue expansion in TED. However, it is expensive, and sometimes, obtaining insurance authorization can be time consuming and difficult. Further work will reveal its full side effect profile and help to establish its role in the armamentarium used to treat TED.


Assuntos
Exoftalmia , Oftalmopatia de Graves , Anticorpos Monoclonais Humanizados/uso terapêutico , Exoftalmia/tratamento farmacológico , Oftalmopatia de Graves/tratamento farmacológico , Humanos , Inflamação/tratamento farmacológico , Estados Unidos
3.
Ned Tijdschr Geneeskd ; 1662022 02 16.
Artigo em Holandês | MEDLINE | ID: mdl-35499767

RESUMO

Graves' orbitopathy may cause multiple symptoms, such as proptosis, redness or inflammation of the conjunctiva, excessive tearing, swelling of the eyelids and pain. Smoking, male gender and old age are significant risk factors for a more severe and active disease.


Assuntos
Exoftalmia , Oftalmopatia de Graves , Doenças do Aparelho Lacrimal , Exoftalmia/complicações , Exoftalmia/etiologia , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/etiologia , Humanos , Inflamação/complicações , Masculino
4.
Zh Vopr Neirokhir Im N N Burdenko ; 86(2): 103-108, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35412719

RESUMO

OBJECTIVE: To demonstrate own experience in 3D modeling for planning of minimally invasive approach to the orbit and anterior skull base. MATERIAL AND METHODS: A 17-year-old patient admitted to the Department of Pediatric Neurosurgery with complaints of decreased visual acuity of the left eye, lacrimation and exophthalmos. MRI revealed a tumor of the left orbit. We have preoperatively modeled frontoorbital region, anterior skull, as well as eyeball and tumor within the same model. Considering young age and potentially favorable prognosis of disease, we preferred a minimally invasive intervention (microsurgical resection of tumor through minimally invasive frontoorbital access). RESULTS: Total resection of tumor was followed by examination of anterior skull base. There was postoperative regression of visual disturbances, lacrimation and exophthalmos. Sutures were removed after 5 days, and the patient was discharged. CONCLUSION: Minimally invasive frontoorbital access is adequate for approach to the orbit, anterior and middle cranial fossa, adequate resection of orbital tumor and examination of anterior skull base. 3D modeling is an additional preoperative tool to improve the quality of preoperative planning and facilitate intraoperative navigation.


Assuntos
Exoftalmia/cirurgia , Órbita/cirurgia , Neoplasias Orbitárias/cirurgia , Adolescente , Criança , Fossa Craniana Média , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Humanos , Imageamento Tridimensional , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos , Órbita/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico por imagem
5.
Jpn J Ophthalmol ; 66(3): 314-319, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35438395

RESUMO

PURPOSE: Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial disease characterized by slowly progressive ptosis and limitations in ocular motility. Although exophthalmos is not considered to be a common feature of CPEO, this study focused on the incidence of exophthalmos in patients with CPEO. STUDY DESIGN: Retrospective observational case series METHODS: We reviewed the clinical charts of patients who received a diagnosis of CPEO sometime during the period between January 2010 and December 2018. CPEO was diagnosed on the basis of detection of a deletion of mitochondrial DNA (mtDNA) from saliva, buccal mucosa, or extraocular muscle specimens obtained during strabismus surgery. Horizontal MRI/CT images or Hertel ophthalmometry was used in determining exophthalmos. RESULTS: Seven patients (4 males) were identified. The mean age at diagnosis was 32.6 years (range 13-53 years). mtDNA deletion mutations were detected in the buccal mucous membrane DNA in 5 patients and in the saliva and extraocular muscle DNA in 2 patients. MRI/CT was recorded in 6 patients, four of whom showed exophthalmos (cases 1-4), and case 5 was determined as exophthalmos on the basis of a Hertel ophthalmometer reading. Exophthalmos was bilateral in 4 of the patients (cases 1, 2, 4, and 5) and unilateral in 1 patient (case 3). Exophthalmos was the chief concern of 2 of the patients; however, it was not clinically significant in the other patients. CONCLUSIONS: Although exophthalmos may not be recognized by either the patient or the clinician, it may be one of the common features of CPEO. A large multiethnic study should be performed.


Assuntos
Exoftalmia , Oftalmoplegia Externa Progressiva Crônica , Adolescente , Adulto , DNA Mitocondrial/genética , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores , Oftalmoplegia Externa Progressiva Crônica/complicações , Oftalmoplegia Externa Progressiva Crônica/diagnóstico , Oftalmoplegia Externa Progressiva Crônica/genética , Estudos Retrospectivos , Adulto Jovem
6.
Prenat Diagn ; 42(5): 589-600, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35373843

RESUMO

INTRODUCTION: Raine syndrome is an autosomal recessive disorder characterized mainly by the presence of exophthalmos, choanal atresia or stenosis, osteosclerosis, and cerebral calcifications. There are around 50 cases described in the literature with a prevalence of less than 1/1,000,000. It is secondary to pathogenic variants in the FAM20 C gene, located on chromosome 7p22.3. CASE REPORT: We report a consanguineous family with three affected pregnancies. In the first two, exophthalmos and bone abnormalities were noted, ending in one intra-uterine demise and one neonatal death, without identifying any genetic disorder. During the couple's most recent pregnancy, fetal anomaly sonogram and fetal CT scan revealed microcephaly, intracranial calcifications, exophthalmos, hypertelorism, depressed nasal bridge, midface hypoplasia and thoracic hypoplasia. Fetal blood sampling for whole exome sequencing revealed a novel pathogenic homozygous variant c.1363+1G > A in the FAM20 C gene associated with Raine syndrome. Delivery occurred at 26 weeks of gestation after rupture of membranes followed by neonatal death due to respiratory failure. REVIEW: A review of the distinctive features of Raine syndrome, the contribution of different prenatal imaging modalities (Ultrasound, Computed Tomography and Magnetic Resonance Imaging) in making the diagnosis and the molecular characterization of this disorder is provided.


Assuntos
Calcinose , Exoftalmia , Morte Perinatal , Anormalidades Múltiplas , Caseína Quinase I/genética , Fissura Palatina , Proteínas da Matriz Extracelular/genética , Feminino , Humanos , Recém-Nascido , Microcefalia , Mutação , Osteosclerose , Gravidez
7.
J Craniofac Surg ; 33(2): e191-e194, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35385240

RESUMO

ABSTRACT: Crouzon syndrome, also known as craniofacial dysostosis, is an autosomal dominant inherited disease characterized by early cranial fusion and consequential craniofacial malformations. In patients with Crouzon syndrome, the growth of the midface is affected due to early fusion of the cranial base, which results in exophthalmos, ocular ptosis, midface deficiency, and maxillary retrognathism. Frontofacial advancement using Le Fort III osteotomy is the conventional method for treating patients with Crouzon syndrome. However, this procedure has drawbacks such as extensive operation field and high possibility of serious complications (eg, meningitis). For patients with mild symptoms, facial esthetics and proper occlusion can be promoted through conventional orthognathic surgery, but midface deficiency cannot be completely resolved. Thus, in this case report, midface augmentation was performed for a patient with Crouzon syndrome by undergoing conventional orthognathic surgery, along with patient-specific implants made using a 3D virtual technique. Implants were 3D printed using polyetherketoneketone and simultaneously implanted during the orthognathic surgery. After the surgery, not only were the patient's occlusion and facial esthetics improved, but also exophthalmos and ocular ptosis were reduced by the midfacial augmentation effect of patient-specific implants placed in the midface. Since the implants were made exactly as what surgeons have intended through computer-aided design (CAD)/computer-aided manufacturing (CAM) and 3D printing techniques, problems such as under-/over-correction were avoided. In addition, the possibility of implant malpositioning was minimized using surgical stents as implants were passively fitted on the patient's bone surface. This case verified that the application of 3D technology to the field of oral and maxillofacial surgery can reduce the invasiveness of surgery and improve the accuracy of the operation. Therefore, by using cutting-edge technologies, the field of oral and maxillofacial surgery is expected to be developed further in the near future.


Assuntos
Disostose Craniofacial , Implantes Dentários , Exoftalmia , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Disostose Craniofacial/cirurgia , Humanos , Osteotomia de Le Fort/métodos
8.
BMJ Case Rep ; 15(3)2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241450

RESUMO

A postpartum woman presented with sudden-onset left eyelid swelling and severe pain. Clinical examination revealed left exophthalmos and ophthalmoplegia with marked resistance to retropulsion of the left globe. The patient was not able to perceive light in the affected left eye and a relative afferent pupillary defect was present. CT orbits showed an enhancing lesion in the left retrobulbar space, suggestive of a lateral rectus haemorrhage. An emergency left lateral canthotomy and inferior cantholysis was performed. A day later, an MRI showed expansion of the left lateral rectus with significant mass effect on the globe. As the visual acuity remained reduced at counting fingers and there was a persistent relative afferent pupillary defect (RAPD), an exploratory orbitotomy and haematoma evacuation was performed. Three days postoperatively, the visual acuity had returned to 6/6. Eye movements normalised within 2 weeks and follow-up imaging revealed near complete resolution of the haematoma.


Assuntos
Exoftalmia , Hemorragia Retrobulbar , Exoftalmia/diagnóstico , Feminino , Humanos , Músculos Oculomotores , Órbita/cirurgia , Período Pós-Parto , Hemorragia Retrobulbar/diagnóstico
9.
Neurol India ; 70(1): 296-299, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35263899

RESUMO

Only three cases of pleomorphic adenomas (PAs) of ectopic lacrimal gland mass in deep orbital location have been reported in the literature. This report describes a case of PA of the ectopic lacrimal gland situated deep in the orbit leading to proptosis, which was managed successfully by supraorbital orbitotomy via eyebrow incision. A 60-year-old female presented with complaints of gradually progressive, painless proptosis of the right eye. Imaging revealed a well-defined circumscribed mass lesion in the right orbit located predominantly in the postero-superior aspect of the globe. The patient underwent complete excision through supraorbital orbitotomy approach, using eyebrow incision. There was no clinical evidence of recurrence at eight months follow up. In orbit, PAs of the ectopic lacrimal gland are extremely rare, and the success of the treatment depends on the removal of the tumor with its capsule.


Assuntos
Adenoma Pleomorfo , Exoftalmia , Aparelho Lacrimal , Adenoma Pleomorfo/diagnóstico por imagem , Adenoma Pleomorfo/patologia , Adenoma Pleomorfo/cirurgia , Feminino , Cabeça/patologia , Humanos , Aparelho Lacrimal/diagnóstico por imagem , Aparelho Lacrimal/patologia , Aparelho Lacrimal/cirurgia , Pessoa de Meia-Idade
10.
Neurol India ; 70(1): 337-339, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35263908

RESUMO

Background: Hydatid cyst is a parasitic infection caused by Echinococcus granulosus and human is an accidental host. Liver and lungs are the most widely recognized organ of association but relatively low in other organs. Orbital involvement of the hydatid cyst is rare. Case Description: The case was a 47-year-old lady presented in the late stage of disease when corneal ulcer had developed and with complete vision loss along with headache, proptosis, and pain in the left eye. Cystic lesion in the retro-orbital region of the left eye was revealed by Computed tomography scan and magnetic resonance imaging. The patient underwent surgery. Hundreds of daughter cysts were seen intraoperatively and cyst wall sent for histopathological examination to confirm the diagnosis. The patient was further treated with albendazole for 3 months. Conclusion: Although hydatid cyst is uncommon, it ought to be considered in the differential diagnosis of cystic lesion of orbital locale, more so in the endemic territories.


Assuntos
Equinococose , Echinococcus , Exoftalmia , Albendazol/uso terapêutico , Animais , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Exoftalmia/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade
11.
Cells ; 11(5)2022 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-35269521

RESUMO

Redox homeostasis and redox-mediated signaling mechanisms are fundamental elements of human biology. Physiological levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS) modulate a range of functional processes at the cellular, tissue, and systemic levels in healthy humans. Conversely, excess ROS or RNS activity can disrupt function, impairing the performance of daily activities. This article analyzes the impact of redox mechanisms on extreme task performance. Such activities (a) require complex motor skills, (b) are physically demanding, (c) are performed in an extreme environment, (d) require high-level executive function, and (e) pose an imminent risk of injury or death. The current analysis utilizes race car driving as a representative example. The physiological challenges of this extreme task include physical exertion, g loading, vibration, heat exposure, dehydration, noise, mental demands, and emotional factors. Each of these challenges stimulates ROS signaling, RNS signaling, or both, alters redox homeostasis, and exerts pro-oxidant effects at either the tissue or systemic levels. These redox mechanisms appear to promote physiological stress during race car driving and impair the performance of driver athletes.


Assuntos
Atletas , Osteosclerose , Anormalidades Múltiplas , Fissura Palatina , Exoftalmia , Humanos , Microcefalia , Oxirredução , Espécies Reativas de Oxigênio
12.
Arch Endocrinol Metab ; 66(2): 191-197, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35315985

RESUMO

Objective: Graves' ophthalmopathy (GO) is a vision-threatening finding observed in approximately half of Graves' disease patients. The pathophysiology of GO is unclear, and one of the suspected factors is oxidative stress. In our study, we compared the relationship between proptosis and SH-SS in patients diagnosed with GO. Methods: In this prospective study, 40 recently diagnosed Graves' disease patients with proptosis, 40 recently diagnosed Graves' disease patients without GO and 30 healthy individuals with similar demographic characteristics were included. Serum thiol-disulfide (SH-SS) measurements were performed. Eye examinations were performed by a single ophthalmologist to check for the presence of GO, and proptosis values were recorded with a Hertel exophthalmometer. Results: Total SH values were lower in the group with proptosis than in the other groups (p < 0.05). Total and native SH values were lower in patients without proptosis than in the control group (p < 0.05). Total SH, native SH and SS levels were independently associated with proptosis (p < 0.05). According to this analysis, it was found that increasing SS and decreasing total and native SH levels increased the probability of proptosis by 24.4%, 32.7% and 32.4%, respectively. Conclusion: A decrease in SH, which is a natural antioxidant that protects the body against oxidative stress, and an increase in SS are important signs of oxidative damage. Proptosis and SH-SS are closely related in GO. This may help us detect GO and proptosis in Graves' patients. It can also assist in developing new options for preventing and treating GO.


Assuntos
Exoftalmia , Doença de Graves , Oftalmopatia de Graves , Dissulfetos , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Humanos , Estudos Prospectivos , Compostos de Sulfidrila
13.
PLoS One ; 17(3): e0265324, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35275980

RESUMO

PURPOSE: This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. METHODS: Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. RESULTS: Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. CONCLUSION: In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.


Assuntos
Exoftalmia , Oftalmopatia de Graves , Cefalometria , Exoftalmia/diagnóstico por imagem , Exoftalmia/cirurgia , Feminino , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Órbita/anatomia & histologia , Estudos Retrospectivos
14.
BMJ Case Rep ; 15(2)2022 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-35140092

RESUMO

A male in his early teens presented with redness of the right eye following a fall. This redness was progressive and increased suddenly over the week prior to presentation. Fundus evaluation revealed an exudative retinal detachment, and a bruit was audible over the right eye. A digital subtraction angiogram revealed the cause to be a ruptured persistent trigeminal artery aneurysm causing a carotid-cavernous fistula like haemodynamic situation with a massively dilated superior ophthalmic vein. Curative embolisation was done using both vertebrobasilar and carotid approach, and the aneurysm as well as the fistula was occluded using detachable coils and n-butyl cyanoacrylate glue. Patient made a complete recovery in his proptosis and chemosis over 8 weeks, with significant improvement of his visual acuity. The key to successful outcome in this case was a complete occlusion with thrombosis of the fistula bed that can only be achieved using a combination of coils and liquid embolic agents.


Assuntos
Fístula Carotidocavernosa , Seio Cavernoso , Embolização Terapêutica , Exoftalmia , Adolescente , Angiografia , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Exoftalmia/etiologia , Humanos , Masculino
15.
Arch Soc Esp Oftalmol (Engl Ed) ; 97(2): 81-88, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35152953

RESUMO

BACKGROUND AND OBJECTIVE: Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20%-42%. The clinical presentation and survival is presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS: Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastasis involving the orbit was included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS: One-half (50%) of the patients were women. Mean age at diagnosis was 60.9 years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases); followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation, and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8 months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5 months) and in the active treatment group (median 29.2 months), p=.034. CONCLUSIONS: In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.


Assuntos
Exoftalmia , Neoplasias Orbitárias , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Órbita , Exenteração Orbitária , Neoplasias Orbitárias/cirurgia , Estudos Retrospectivos
16.
Medicina (Kaunas) ; 58(2)2022 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-35208640

RESUMO

Carcinosarcomas are biphasic tumors comprising carcinoma and sarcoma components that occur in many tissues but are rarely found in the orbit. A 70-year-old male presented to the ophthalmic clinic with progressive proptosis, having decreased vision in the left eye for 8 months. On examination, severe exophthalmos and lagophthalmos with limited extraocular movement were noted. Orbital computed tomography scans revealed a large, well-defined, heterogeneously enhanced mass in the left retrobulbar orbital cavity. The tumor was completely resected, and the pathological examination revealed a carcinosarcoma. The prognosis was excellent without local recurrence at 48 months postoperatively. Thus, when considering treatment for effective management of such tumors, tumor resection followed by radiotherapy or chemotherapy is highly recommended.


Assuntos
Carcinossarcoma , Exoftalmia , Idoso , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/radioterapia , Carcinossarcoma/cirurgia , Exoftalmia/etiologia , Humanos , Masculino , Órbita/diagnóstico por imagem , Órbita/cirurgia , Prognóstico , Tomografia Computadorizada por Raios X
17.
JAMA Ophthalmol ; 140(4): 328-335, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35175308

RESUMO

IMPORTANCE: Thyroid eye disease can be a debilitating autoimmune disorder characterized by progressive proptosis or diplopia. Teprotumumab has been compared with placebo in randomized clinical trials, but not with intravenous methylprednisolone (IVMP), which sometimes is used in clinical practice for this condition. OBJECTIVE: To conduct a matching-adjusted indirect comparison of teprotumumab vs IVMP vs placebo. DATA SOURCES: Deidentified patient-level data from teprotumumab trials and aggregate-level data from literature on the most recommended regimen of IVMP. STUDY SELECTION: PubMed and Embase were searched for randomized/observational studies using key terms and controlled vocabulary. Full texts of eligible articles were reviewed and cataloged. DATA EXTRACTION AND SYNTHESIS: Conducted by 1 reviewer (R.A.Q.) and 1 verifier (R.B.), including study characteristics, eligibility criteria, baseline characteristics, and outcomes. MAIN OUTCOMES AND MEASURES: Changes in proptosis by millimeter and diplopia response (percentage with ≥1 grade reduction) from baseline to week 12 in patients receiving IVMP and placebo, and to week 24 in patients receiving teprotumumab. RESULTS: The search identified 1019 records, and 6 through manual searches, alerts, and secondary references. After excluding duplicates and screening full-text records, 12 IVMP studies were included in the matching-adjusted indirect comparison (11 for proptosis change [n = 419], 4 for diplopia response [n = 125], and 2 teprotumumab [n = 79] and placebo [n = 83] comparator studies). Treatment with IVMP resulted in a proptosis difference of -0.16 mm (95% CI, -1.55 to 1.22 mm) from baseline to week 12 vs placebo. The proptosis treatment difference between IVMP and teprotumumab of -2.31 mm (95% CI, -3.45 to -1.17 mm) favored teprotumumab. Treatment with IVMP (odds ratio, 2.69; 95% CI, 0.94-7.70) was not favored over placebo in odds of diplopia response; however, teprotumumab was favored over IVMP (odds ratio, 2.32; 95% CI, 1.07-5.03). CONCLUSIONS AND RELEVANCE: This meta-analysis suggests that use of IVMP is associated with a small, typically not clinically relevant, change from baseline in proptosis vs placebo, with modest changes in diplopia. While this nonrandomized comparison suggests that use of teprotumumab, compared with IVMP, is associated with greater improvements in proptosis and may be twice as likely to have a 1 grade or higher reduction in diplopia, randomized trials comparing these 2 treatments would be warranted to determine if 1 treatment is superior to the other to a clinically relevant degree.


Assuntos
Exoftalmia , Oftalmopatia de Graves , Anticorpos Monoclonais Humanizados , Diplopia/diagnóstico , Diplopia/tratamento farmacológico , Exoftalmia/tratamento farmacológico , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/tratamento farmacológico , Humanos , Metilprednisolona/uso terapêutico
19.
J Craniomaxillofac Surg ; 50(4): 298-303, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35067421

RESUMO

Orbital subperiosteal hematoma (OSPH) is a rare entity following blunt trauma that can significantly affect the vision of a growing child. The purpose of this study was to describe the spectrum of the clinical presentations along with the imaging findings and treatment outcome of traumatic OSPH. This is a retrospective case series of six patients below 16 years of age, diagnosed with OSPH following trauma. Electronic medical records were reviewed for details of clinical features, imaging findings, management details and outcomes. The median duration of the presentation was 7 days (range 6-50 days). Proptosis and dystopia remained the most common presenting features. Significant vision loss was noted in four patients at presentation. A computed tomography (CT) scan revealed the superior quadrant of the orbit to be involved most frequently. Five patients were treated surgically and one conservatively. Significant vision loss was noted in one patient despite of initial surgical management. Although rare, OSPH should be considered a differential diagnosis in children presenting with proptosis and dystopia following blunt trauma. Younger children are particularly at higher risk for developing permanent visual loss and should be treated promptly by draining the OSPH.


Assuntos
Doenças Ósseas , Exoftalmia , Doenças Orbitárias , Ferimentos não Penetrantes , Cegueira , Criança , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Órbita/diagnóstico por imagem , Órbita/lesões , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/etiologia , Doenças Orbitárias/terapia , Estudos Retrospectivos , Transtornos da Visão , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia
20.
Orbit ; 41(1): 69-78, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33059514

RESUMO

AIM: To study the clinical presentation, disease characteristics, and management approach for children with thyroid eye disease (TED) over a 10 year period in a multidisciplinary Paediatric Thyroid Eye Disease Clinic at a tertiary care referral center. METHODS: Retrospective case series of patients with TED at Kandang Kerbau Women's and Children's Hospital (KKWCH) Singapore between August 2006 to June 2015. The diagnosis of TED was clinical based on the Bartley criteria. Ophthalmic examination findings, systemic thyroid function and ophthalmological intervention were recorded. RESULTS: Nineteen subjects with pediatric TED were studied. The median age at diagnosis was 12.5 years (range 6-17). The onset of TED was at the same time as their thyroid disease in half of these patients (52.6%) of which all were hyperthyroid except one. The most common signs at TED diagnosis were proptosis (84.2%), lid retraction (63.2%), acquired epiblepharon (63.2%). All patients were inactive and none had evidence of compressive optic neuropathy. TED remained stable in all patients except for one who developed worsening proptosis with exposure keratopathy. No patients were prescribed steroids (oral or intravenous) or had orbital decompression surgery. The most debilitating morbidity was acquired epiblepharon of which out of 12 patients, one had everting sutures and three were offered surgical correction. CONCLUSIONS: Paediatric TED subjects exhibit milder clinical manifestations compared to adults. Acquired epiblepharon causes most significant visual morbidity by compromising the corneal surface. Being cognizant of the subtleties of pediatric TED will permit the discerning clinician to effectively manage such cases accordingly.


Assuntos
Exoftalmia , Oftalmopatia de Graves , Adolescente , Adulto , Criança , Exoftalmia/diagnóstico , Exoftalmia/epidemiologia , Pálpebras , Feminino , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/epidemiologia , Oftalmopatia de Graves/terapia , Humanos , Órbita , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...