The method of the exophthalmos value predicted calculation when planning the orbital decompression procedure in patients with endocrine ophthalmopathy

BACKGROUND: The most effective method of surgical treatment of lipogenic and mixed forms of edematous exophthalmos is currently the internal orbital decompression. During this surgical procedure, the excessive pathologically altered adipose tissue is removed from the external and the internal surgical spaces of the orbit. Many scientists are developing methods for calculating the volume of orbital fat, but the question on developing a method for predicted exophthalmos after internal orbital decompression, which could be used without attracting additional equipment and software, is easy to learn and does not require a long calculation time, remains actual. This method has to take into account the individual features of the patients orbital structure and be used for calculations in the bilateral proptosis correction. AIM: To develop and evaluate the effectiveness of a new method for calculating the eyeball position after orbital decompression. MATERIALS AND METHODS: 64 patients (126 orbits) with lipogenic and mixed forms of endocrine ophthalmopathy were examined. All patients underwent internal orbital decompression, during which the orbital fat was removed, the volume of which was calculated according to the developed original method. Patients underwent ophthalmological examination and MSCT before surgery and 6 months after it. . RESULTS: As a result of orbital decompression in the examined group, a decrease in proptosis was observed in all patients, and the exophthalmos calculated by the method corresponded to the eyeball position in patients in 6 months after surgery. The level of statistical significance of the planned postoperative eyeball position in relation to the actual postoperative exophthalmos calculated according to the Students t-test was 0.98 (p 0.05), that is, it can be argued that the groups do not differ, and no statistically significant differences were found. CONCLUSIONS: The developed method for calculating the estimated postoperative exophthalmos is effective without using additional software. This technique allows you to achieve a symmetrical eyeball position in the postoperative period and to reduce the risk of complications.

Optical neuropathy and edematous exophthalmos. New approaches to treatment

Purpose. To study the clinical effectiveness of the administration of complex therapy of drugs to the hemolymphocirculatory organ (pterygopalatine fossa) in edematous exophthalmos in patients with endocrine ophthalmopathy complicated by optical neuropathy. Material and methods. The analysis of the results of treatment of 31 patients (62 eyes) with edematous exophthalmos on the background of endocrine ophthalmopathy complicated by optical neuropathy, who applied for help in the Novosibirsk branch of "MNTC "Eye Microsurgery". All patients were prescribed a 10-day course of intensive complex treatment, consisting of injections into the region of hemolymphocirculation (pterygeal fossa) No. 6 (No. 3 on each side) with an interval of 24 hours of a drug mixture, the formulation of which included Lidocaine 20 mg, Dexazone 4 mg, Hemase 3000 units, Dalargin 1 mg, with additional administration of antioxidants, neuroprotectors, vitamins and keratoprotectors. Results. By the end of treatment, all patients had a pronounced positive trend in the form of a significant (from 0.6 to 1.0) increase in visual acuity, a decrease in exophthalmos (from 2,0 to 3,0 mm), and an increase in color and contrast sensitivity. Conclusions. Due to the violation of venous and lymphatic outflow due to the thickening of extraocular muscles and retrobulbar fiber, injection of drugs with a wide range of decongestant and metabolic effects into the hemolymphocirculation region (pterygeal fossa) is justified and effective. Key words: endocrine ophthalmopathy, optical neuropathy, complex therapy.

Hypotensive therapу of secondary glaucoma in patients with endocrine ophthalmopathy

Objective: to evaluate the efficiency of monotherapy and fixed combination therapy of secondary glaucoma (SG) in patients with endocrine ophthalmopathy (EOP).Materials and methods. We examined 145 patients (290 eyes and orbits) with different forms and activity of EOP. Among them, 30 patients (58 eyes and orbits) were diagnosed with ″SG detected for the first time and associated with EOP″ (20 % of the cases).The patients with SG received beta-adrenoblockers (BA) or prostaglandin analogues (PGA) as initial monotherapy. Two weeks later, in the absence of intraocular pressure (IOP) compensation, fixed combinations of beta-blocker/carbonic or anhydrase inhibitor (BB/CAI) or beta-blocker/prostaglandin analogue (BB/ PGA) were prescribed.Results. The PGA monotherapy reduced the IOP level by 29 % compared to the baseline level in 33 % of the cases in increased ophthalmic tonus within Me 27 [26;28] mm Hg. (Wilcoxon test, p = 0.005). In IOP levels over 29 [28;31] mmHg, BB/PGA fixed combination therapy reduced IOP by 33 % from the baseline level.Conclusion. SG monotherapy in patients with EOP is effective in increased IOP within Me 27 [26;28] mmHg. In initial IOP levels higher than 29 [28;31] mmHg, it is expedient to prescribe BB/PGA fixed combination therapy as initial therapy.

MicroRNA and endocrine ophthalmopathy, involvement in glucocorticoid response

The accumulated clinical experience proves the existence of glucocorticoid-resistant forms of endocrine ophthalmopathy. It is assumed that epigenetic factors (miRNA) affect the pathogenesis of the disease and are involved in the formation of the glucocorticoid response. Purpose. To study the role of miRNA-146a and miRNA-155 in patients with clinical forms of endocrine ophthalmopathy and to assess their effect on the glucocorticoid response. Material and method: The study included 20 patients (40 orbits) with image intensifier tubes, treated with glucocorticoids (GC) with a negative result, mean age – 52.65 ± 12.6 years. The control group - 28 volunteers without autoimmune and tumor diseases, age 62.9 ± 7.54 years. The expression level of miRNA-155 and miRNA-146a was determined by real-time PCR. Results: The obtained data indicate an increase in the expression level of miRNA-146a and miRNA-155 in patients with clinical forms of endocrine ophthalmopathy at the stage of fibrosis (p <0.01). Conclusion: The obtained results of the functional activity of miRNA-146a and miRNA-155 confirm their participation in the pathogenesis of the development of edematous exophthalmos and endocrine myopathy by activating the fibroplastic process. Key words: endocrine ophthalmopathy, GC therapy, microRNA.

Transorbital Endoscopic Medial Orbitotomy and Decompression of the Optic Nerve in Patients with Endocrine Ophthalmopathy Complicated by Optical Neuropathy

AIM OF STUDY: to improve the results of surgical treatment of patients with endocrine ophthalmopathy complicated by optical neuropathy. For this, medial orbitotomy and decompression of the optic nerve were performed for a patient with endocrine ophthalmopathy, CAS<3, OD=18 mm, OS=23 mm and visual acuity OD=1.0 OS=0.2, using transorbital transconjunctival endoscopic access. The first step was a retro caruncular incision. After that, we defined an access to the medial wall of the orbit with its subsequent resection. Then, we performed ethmoidectomy and approach to the optic nerve canal. Upon completion of bone decompression, we opened periorbitis.RESULTS. The postoperative period was uneventful. In the early postoperative period, regression of exophthalmos was observed OD=18 mm, OS=20 mm, improvement in visual acuity OD=1.0 OS=0.5 . No complications were recorded. A satisfactory result was obtained.CONCLUSION. Transorbital endoscopic medial orbitotomy and optic decompression can be effectively used in the treatment of patients with endocrine ophthalmopathy complicated by optic neuropathy, refractory to conservative therapy. The technique is promising and requires further randomized studies.

Endocrine ophthalmopathy: pharmacogenetic markers of efficiency of glucocorticoid therapy

The pathological process of endocrine ophthalmopathy is based on damage to the soft tissues of the orbit against the background of impaired thyroid function and even its euthyroid state. The pathogenetic mechanisms of the development of clinical symptoms of endocrine ophthalmopathy (EOP) are based on morphological changes in extraocular muscles (EOM) and orbital tissue: cellular tissue infiltration by representatives of the immune system (T- and B-lymphocytes, macrophages, mast and plasma cells), with the production of pro-inflammatory cytokines, fibroblasts and glycosaminoglycans, contributing to an increase in the contents of the orbit in volume with the development of exophthalmos and tissue fibrosis at the end of the inflammatory process. Glucocorticoids are the gold standard for the pathogenetic treatment of patients with clinical forms of endocrine ophthalmopathy: edematous exophthalmos and endocrine myopathy. The properties of drugs of this group are such that they can be used to suppress all stages of inflammation in the orbital tissues, preventing the progression of the disease. Despite the many years of experience in applying various glucocorticoid therapy techniques, to date there are no uniform criteria for the effectiveness of this treatment in patients with endocrine ophthalmopathy. The article presents the features of glucocorticoid therapy of endocrine ophthalmopathy, as well as literature data, on the basis of which attempts have been made to explain the causes of glucocorticoid resistance taking into account the pharmacogenetic profile.