Ana Beatriz Diniz Grisolia

The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp.

Demodex folliculorum and D brevis are common ectopic parasites that inhabit the pilosebaceous units of the human skin. They are associated with dermatological problems such as acne, rosacea and folliculitis.1 In ophthalmology, they are considered an aetiological factor of chronic blepharitis, meibomian gland dysfunction and ocular surface inflammation. Pathogenesis is controversial as Demodex can also be found in many asymptomatic patients. In this study, we aimed to investigate the efficacy and safety of the oral use of ivermectin in the treatment of chronic, recalcitrant blepharitis.nnPatients diagnosed as having chronic symptomatic blepharitis resistant to conventional treatment were included (figure 1A). The participants provided written informed consent, and the study was approved by the institutional review board/ethics committee and followed the tenets of the Declaration of Helsinki. All patients underwent a thorough ophthalmic examination, including tear break-up time (BUT), symptoms questionnaire and ocular surface disease index (OSDI), and were tested for the presence …

Slit2 Modulates the Inflammatory Phenotype of Orbit-Infiltrating Fibrocytes in Graves’ Disease

Human CD34+ fibrocytes, circulating monocyte lineage progenitor cells, have recently been implicated in thyroid-associated ophthalmopathy (TAO), the ocular manifestation of Graves’ disease (GD). Fibrocytes express constitutive MHC class II (MHC-2) and, surprisingly, thyroglobulin (Tg) and functional thyrotropin (TSH) receptor (TSHR). Underlying expression of these thyroid proteins is the autoimmune regulator protein (AIRE). Fibrocytes respond robustly to TSH and thyroid-stimulating Igs by generating extremely high levels of inflammatory cytokines, such as IL-6. In TAO, they appear to infiltrate the orbit, where they transition to CD34+ orbital fibroblasts (OF). There, they coexist with CD34− OF as a mixed fibroblast population (GD-OF). In contrast to fibrocytes, GD-OF express vanishingly low levels of MHC-2, Tg, TSHR, and AIRE. Further, the amplitude of IL-6 induction by TSH in GD-OF is substantially lower. The molecular basis for this divergence between fibrocytes and CD34+ OF remains uncertain. In this article, we report that Slit2, an axon guidance glycoprotein, is constitutively expressed by the CD34− OF subset of GD-OF. Culture conditioned medium (CM) generated by incubating with GD-OF and CD34− OF substantially reduces levels of MHC-2, Tg, TSHR, and AIRE in fibrocytes. Expression can be restored by specifically depleting CM of Slit2. The effects of CD34− OF CM are mimicked by recombinant human Slit2. TSH induces Slit2 levels in GD-OF by enhancing both Slit2 gene transcription and mRNA stability. These findings suggest that Slit2 represents a TSH-inducible factor within the TAO orbit that can modulate the inflammatory phenotype of CD34+ OF and therefore may determine the activity and severity of the disease.

Non-surgical treatment for eyelid retraction in thyroid eye disease (TED)

Thyroid eye disease (TED) is an autoimmune condition with an unpredictable course that may lead to permanent facial disfigurement. Eyelid retraction is one of the most common findings, and frequently demands attention due to ocular exposure and impaired cosmesis. Surgical treatment remains the most effective option, but there is a role for temporary corrections during the active phase of the disease, as well as in patients who are poor surgical candidates. The aim of this review is to describe the non-surgical modalities currently available for treatment of eyelid malposition in TED. The authors have focused on the use of hyaluronic acid, triamcinolone injections and botulinum toxin type A as non-surgical treatment alternatives, paying special attention to dosing, technique, efficacy and duration of effect. Non-surgical treatment modalities may represent viable in cases where surgical correction is not an option. Although temporary, these modalities appear to be beneficial for ocular exposure remediation, improving quality of life and broadening our therapeutic arsenal.

The Use of Integra® Dermal Regeneration Template for the Orbital Exenteration Socket: A Novel Technique.

PURPOSEnIntegra® dermal regeneration template is a bilayer membrane system that acts as a scaffold for regenerating dermal skin cells. It is used for wound reconstruction following burns, extensive injuries, and a large tumor excision in multiple parts of the body. The dermal layer is made of porous matrix of bovine tendon collagen and glycosaminoglycan. The epidermal layer is made of polysiloxane layer. In this study, the authors evaluated the use of Integra® dermal regeneration template for the immediate reconstruction of the orbital exenteration socket.nnnMETHODSnFive patients who underwent exenteration and immediate reconstruction of the socket with Integra® dermal regeneration template were included in this study. Demographic and clinical features, healing time, complications, and follow-up time were recorded.nnnRESULTSnThe study included 4 male patients and 1 female patient with a mean age of 74 years (range, 49-87 years). The primary diagnoses were orbital extension of conjunctival melanoma in 2 patients, squamous cell carcinoma in 1 patient, and uveal melanoma in 1 patient, and aggressive orbital Wegener granulomatosis in 1 patient. There was no postoperative infection, necrosis, hematoma, or fluid accumulation in any patients. The mean postoperative follow-up period was 20 months (range, 11-42 months). The sockets were completely granulated by 4 weeks, and epithelized, getting ready for the prosthesis in 8 weeks.nnnCONCLUSIONSnIntegra® dermal regeneration template can be used for the immediate reconstruction of the socket following exenteration. It is easy to use, and provides a short healing time without any need for any additional reconstructive procedures.

Update on thyroid-associated Ophthalmopathy with a special emphasis on the ocular surface

Thyroid-associated ophthalmopathy (TAO) is a condition associated with a wide spectrum of ocular changes, usually in the context of the autoimmune syndrome, Graves’ disease. In this topical review, we attempted to provide a roadmap of the recent advances in current understanding the pathogenesis of TAO, important aspects of its clinical presentation, its impact on the ocular surface, describe the tissue abnormalities frequently encountered, and describe how TAO is managed today. We also briefly review how increased understanding of the disease should culminate in improved therapies for patients with this vexing condition.

Imaging of Neovascular Membrane Over a Choroidal Osteoma by OCT Angiography

3 Department of Pathology, University of Cambridge, Cambridge, United Kingdom. 4 Research Department of Cell and Developmental Biology, University College London, London, United Kingdom. 5 Regional Molecular Genetic Laboratory, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. 6 Institute of Ophthalmology, University College London, London, United Kingdom. Presented at: The 45th Cambridge Symposium, September 2015, Cambridge, United Kingdom; and the Oxford Ophthalmological Congress, July 2015, Oxford, United Kingdom. Financial Disclosure(s): Supported by University of Cambridge Retinal Research Fund, Cambridge, United Kingdom; and the Annie Arnold Research Legacy Fund. The sponsor or funding organization had no role in the design or conduct of this research. HUMAN SUBJECTS: Ocular tissue included in this study was obtained from donated human eyes following corneal harvesting for transplantation. This project was conducted after National Research Ethics Service approval

CD34− Orbital Fibroblasts From Patients With Thyroid-Associated Ophthalmopathy Modulate TNF-α Expression in CD34+ Fibroblasts and Fibrocytes

Purpose Orbital fibroblasts from patients with Graves disease (GD-OF) express many different cytokines when treated with bovine thyrotropin (bTSH). The present study aimed to determine why TNF-α cannot be induced by bTSH in GD-OF. Methods Fibrocytes and GD-OFs were cultivated from donors who were patients in a busy academic medical center practice. Real-time PCR, Western blot analysis, reporter gene assays, cell transfections, mRNA stability assays, ELISA, and flow cytometry were performed. Results We found that bTSH induces TNF-α dramatically in fibrocytes but is undetectable in GD-OF. The induction in fibrocytes is a consequence of increased TNF-α gene promoter activity and is independent of ongoing protein synthesis. It could be attenuated by dexamethasone and the IGF-1 receptor inhibiting antibody, teprotumumab. When separated into pure CD34+ OF and CD34− OF subsets, TNF-α mRNA became highly inducible by bTSH in CD34+ OF but remained undetectable in CD34− OF. Conditioned medium from CD34− OF inhibited induction of TNF-α in fibrocytes. Conclusions Our data indicate that CD34− OF appear to release a soluble(s) factor that downregulates expression and induction by bTSH of TNF-α in fibrocytes and their derivative CD34+ OF. We proffer that CD34− OF produce an unidentified modulatory factor that attenuates TNF-α expression in GD-OF and may do so in the TAO orbit.

Teleophthalmology: where are we now?

Information and communication technology has rapidly reached diverse aspects of modern life, including medicine and health-related matters. Aiming to improve teaching, research, and health care delivery for geographic or economic reasons, telemedicine is an ascending trend. Teleophthalmology might be one of the most challenging applications of telemedicine given its need for standardized and high definition digital images. However, technological advances are enhancing information transmission continuously and expanding the potential of teleophthalmology. In this review, we investigate the evolution and current status of teleophthalmology, describe its use in different areas, and explore its applicability. Although teleophthalmology is not a replacement for traditional eye care and still faces challenges for adequate implementation, it represents an effective care delivery method, facilitating appropriate and timely distribution of service especially in remote and/or underdeveloped regions.

Pupila dilatada fixa (síndrome de Urrets-Zavalia) após ceratoplastia lamelar profunda

The Urrets-Zavalia Syndrome presents well described ocular findings, even though its physiopathology is still unsure. Iris ischemia is the most common proposing mechanism. We describe two cases that underwent deep lamellar keratoplasty (DLK) performed by the same surgeon and developed the syndrome. In the first case, the surgical indication was for corneal opacity treatment and, in the second case, for keratoconus treatment. During the post-operatory, both patients developed fixed dilated pupil, which didnt regress completely inspite of the onset treatment.

Ceratoplastia endotelial com desnudamento da Descemet(DSEK) utilizando o dispositivo TAN EndoGlideTM: série de casos

OBJETIVO: Relatar os resultados da ceratoplastia endotelial com desnudamento da Descemet (DSEK) utilizando o dispositivo TAN EndoGlideTM para facilitar a introducao da membrana endotelial. METODOS: Serie de casos consecutivos, prospectiva. Foram incluidos 9 pacientes com edema corneano secundario a disfuncao endotelial. Melhor acuidade visual corrigida, refracao, astigmatismo ceratometrico, espessura corneana central, densidade das celulas endoteliais e complicacoes foram analisadas apos seguimento de seis meses. RESULTADOS: Houve melhora do edema de cornea e da visao em 7 pacientes (77,78%). A melhor acuidade visual corrigida ficou entre 20/40 e 20/200. A densidade endotelial media apos 6 meses variou entre 1.305 cels/mm² e 2.346 cels/mm² com media de perda de 33,14%. Desprendimento de parte do enxerto ocorreu em 1 olho (11,11%), falencia primaria do transplante endotelial em 2 olhos (22,22%). CONCLUSAO: O dispositivo TAN EndoGlideTM facilita a introducao do enxerto na ceratoplastia endotelial com desnudamento da Descemet.