ABSTRACT
Introduction: The clinical use of tacrolimus is characterized by many side effects which include neurotoxicity. In contrast, tacrolimus has also shown to have neuroregenerative properties. On a molecular level, the mechanisms of action could provide us more insight into understanding the neurobiological effects. The aim of this article is to review current evidence regarding the use of tacrolimus in peripheral nerve injuries.Areas covered: Available data on tacrolimus' indications were summarized and molecular mechanisms were elucidated to possibly understand the conflicting neurotoxic and neuroregenerative effects. The potential clinical applications of tacrolimus, as immunosuppressant and enhancer of nerve regeneration in peripheral nerve injuries, are discussed. Finally, concepts of delivery are explored.Expert opinion: It is unclear what the exact neurobiological effects of tacrolimus are. Besides its known calcineurin inhibiting properties, the mechanism of action of tacrolimus is mediated by its binding to FK506-binding protein-52, resulting in a bimodal dose response. Experimental models found that tacrolimus administration is preferred up to three days prior to or within 10 days post-nerve reconstruction. Moreover, the indication for the use of tacrolimus has been expanding to fields of dermatology, ophthalmology, orthopedic surgery and rheumatology to improve outcomes after various indications.
Subject(s)
Nerve Regeneration/drug effects , Peripheral Nerve Injuries/drug therapy , Tacrolimus/administration & dosage , Animals , Calcineurin Inhibitors/administration & dosage , Calcineurin Inhibitors/adverse effects , Calcineurin Inhibitors/pharmacology , Drug Administration Schedule , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/pharmacology , Neurotoxicity Syndromes/etiology , Neurotoxicity Syndromes/physiopathology , Peripheral Nerve Injuries/physiopathology , Tacrolimus/adverse effects , Tacrolimus/pharmacologyABSTRACT
INTRODUCTION AND METHODS: Epiphora, which leads to blurry vision, is the leading symptom for intra- and/or postsaccal lacrimal duct stenosis. Due to the anatomy of the tear duct system, which lies between the fields of ophthalmology and otorhinolaryngology, and due to newly available techniques in interventional radiology to diagnose and treat patients with intra- and postsaccal lacrimal duct stenosis, various methods for diagnosis and treatment are available. We report the results of 107 patients who underwent endonasal dacryocystorhinostomy (DCR) between 2005 and 2011. RESULTS: Prior to the DCR, dacryocystography was performed in 95 of the 107 patients. In 68 of these 95 cases, balloon dilatation was unsuccessful. Histological examination of 64 patients showed chronic inflammation in 61 patients, non-Hodgkin's lymphoma was diagnosed in 2 patients and aspergilloma in1 patient. Over a follow-up time of 6 months to a maximum of 7 years we revised 15 of 107 patients, due to reocclusion after removal of the stent. None of these patients showed recurrence of epiphora. DISCUSSION: In comparison to transcutaneous DCR, endonasal DCR has certain benefits: it is less invasive, no visible scars occur because of the endonasal approach, and the function of the lacrimal pump remains uneffected. Furthermore, the possibility of co-treatment of endonasal pathologies during DCR exists. We observed no serious adverse events in our study group and the success rate was similar to other studies.
Subject(s)
Dacryocystorhinostomy/methods , Dacryocystorhinostomy/statistics & numerical data , Postoperative Complications/epidemiology , Vision Disorders/epidemiology , Vision Disorders/prevention & control , Adult , Comorbidity , Female , Germany , Humans , Lacrimal Duct Obstruction/diagnosis , Lacrimal Duct Obstruction/epidemiology , Male , Middle Aged , Patient Care Team/statistics & numerical data , Prevalence , Risk Factors , Treatment Outcome , Young AdultABSTRACT
A routine examination of the right eye of an asymptomatic 7-year-old boy disclosed slightly prominent, elliptically configured yellowish alterations with irregularly configured central hyperpigmentation temporal to the fovea. On spectral domain optical coherence tomography a well-defined corresponding detachment of the neurosensory retina was identified. The findings are compatible with torpedo maculopathy a rare congenital, usually unilateral lesion Which is normally asymptomatic and shows no progression.
