Quantification of cells expressing the thyrotropin receptor in extraocular muscles in thyroid associated orbitopathy.

BACKGROUND/AIM: Thyroid associated orbitopathy (TAO) and Graves' disease (GD) have an autoimmune pathogenesis, possibly related to the thyrotropin receptor (TSHR). The aim of this study was to determine whether TSHR immunoreactivity is correlated with disease severity or serum TSHR antibody (TRAB) levels. METHODS: Orbital tissues from 30 patients with TAO were compared with those of 20 patients with strabismus and four with non-thyroid orbital inflammation. TSHR was detected by immunohistochemistry and TRAB were measured by radioreceptor assay. RESULTS: No TSHR immunoreactivity was detected in the 24 control orbital tissues, whereas in all TAO biopsies elongated fibroblast-like cells, expressing TSHR, were present. These cells were located between the muscle cells, which were separated by oedema in the acute phase but fibrous tissue in the chronic phase of disease. Semi-thin sections showed numerous mast cells present in the chronic phase and in close contact with adipocytes. The number of TSHR immunostained cells was high in early disease, decreased with disease duration, and was positively correlated with TRAB levels at the onset of TAO. CONCLUSION: TSHR immunoreactivity was demonstrated specifically in TAO orbits which highlights the importance of TRAB early in the pathogenesis.

Neuroophthalmologic manifestations of systemic disease.

Significant contributions on the neuroophthalmologic manifestations of systemic disease have been published in the past year. The first part of this paper is devoted to practical guidelines that may help in the diagnosis and the management of oculomotor disorders, especially in connection with systemic diseases; the second part is focused on specific entities. Including idiopathic intracranial hypertension and ophthalmoplegic migraine in this review might be debatable; however, although the cause of these conditions is still unclear, relevant findings suggest that they may be the consequence of other adjacent processes rather than the cause itself. We believe that the diagnosis of idiopathic intracranial hypertension as well as that of ophthalmoplegic migraine remains a challenging issue for the ophthalmologist and may easily be overlooked.

[Symmetric or asymmetric surgery for basic intermittent exotropia]. / Chirurgie symétrique ou asymétrique dans l'exotropie intermittente de base.

Surgical results after symmetrical and asymmetrical surgery performed by the same surgeon (M.S.) as initial procedure for basic intermittent exotropia were retrospectively analysed in 55 young patients. Twenty-five patients underwent unilateral recess-resect surgery on the non-fixating eye (Groupe 1) and 30 patients bilateral lateral rectus recessions (Group 2). The average age at surgery was 6.5 yrs (range: 2-18). The average post-operative follow-up was 2.81 yrs (range: 0.50-8 yrs), (p = 0.143). Sensory fusion was assessed by the Bagolini straited glasses and/or the Worth test and stereopsis by either the TNO and/or Lang stereoacuity test prior and after surgery. Prior to surgery, 84% of the patients had reached isoacuity. Ocular motility was normal in all patients. The average size of preoperative exotropia measured by prism and alternate cover test was 28 PD (SD = 5) for both Groups. In the immediate postoperative period, 53% of the patients were overcorrected without any statistically significant difference between the 2 groups (p = 0.053). Nine (16%) patients had a "mixed" deviation (from eso- to exo depending of the fixation distance), 8 (15%) patients were orthophoric (20% in Group 1 vs 10% in Group 2) and 9 (16%) patients were undercorrected (12% in Group 1 vs 20% in Group 2). The results at last exam, were similar between the 2 Groups; good or fair alignment was achieved in 29 (53%) patients (p = 0.512); 23 (42%) patients had still X(T) (p = 0.829) and 3 (5%) patients were overcorrected. We concluded that even if the immediate postoperative results seem better with asymmetrical surgery, in the long-term there is no significant difference between the two surgical procedures.

Detection, prevention, and rehabilitation of amblyopia.

The necessity of visual preschool screening for reducing the prevalence of amblyopia is widely accepted. The beneficial results of large-scale screening programs conducted in Scandinavia are reported. Screening monocular visual acuity at 3.5 to 4 years of age appears to be an excellent basis for detecting and treating amblyopia and an acceptable compromise between the pitfalls encountered in screening younger children and the cost-to-benefit ratio. In this respect, several preschoolers' visual acuity charts have been evaluated. New recently developed small-target random stereotests and binocular suppression tests have also been developed with the aim of correcting the many false negatives (anisometropic amblyopia or bilateral high ametropia) induced by the usual stereotests. Longitudinal studies demonstrate that correction of high refractive errors decreases the risk of amblyopia and does not impede emmetropization. The validity of various photoscreening and videoscreening procedures for detecting refractive errors in infants prior to the onset of strabismus or amblyopia, as well as alternatives to conventional occlusion therapy, is discussed.

[How to correct anisometropia?]. / Comment corriger un anisométrope?

Anisometropia may be responsible for aniseikonia. and anisophoria. In children, aniseikonia may create amblyopia. It is of utmost importance to distinguish axial from refractive anisometropia. When the anisometropia is axial in origin, spectacle lenses constitute the treatment of choice (Knapp's law). On the contrary, when the anisometropia is refractive in origin, contact lenses represent the first choice of treatment.

[Amblyopia from anisometropia without strabismus]. / Amblyopie par anisométropie sans strabisme.

Fifty non-strabismic children with primary anisometropia were reviewed retrospectively. At entry, patients ranged in age from 1 to 10 years with an average of 4.5 years. The follow-up ranged from 0.5 to 9 years with an average of 3.5 years. Criteria for inclusion were a difference in refractive error between the two eyes of at least 1.00 D of spherical value and/or 0.75 D of cylindrical value. In all cases, anisometropia was totally corrected by prescribing glasses. Anisometropic amblyopia was considered to be present when isoacuity at far was not reached despite the glasses, part-time occlusion therapy of the good eye was prescribed. Amblyopia was present in 86% of the patients and was found with all types of anisometropia. It was more severe in anisohyperopia and/or anisoastigmatism. After adequate treatment, amblyopia was clinically cured or less severe in 78% of the patients.

Comitant strabismus.

This article briefly overviews the recent literature regarding comitant strabismus. The evaluation and management of esodeviations and exodeviations, which are still topical questions today, are discussed. Several relevant basic studies focus on the prevalence and the role of sensory mechanisms in the clinical findings of essential infantile esotropia. Data reported on by the authors reinforce the validity of early surgery in congenital strabismus. Other articles deal with the accommodative esotropia. The beneficial effect of adequate corrective eyeglasses in accommodative esotropia is emphasized, in both children and adult patients. A major informative review of intermittent exotropia and a worldwide survey of current management of intermittent exotropia are also presented.

[Accommodation insufficiency in children]. / Insuffisance d'accommodation chez l'enfant.

Insufficiency of accommodation in children is often misdiagnosed, and particularly in preschool age. Subject if symptoms are unspecific, asthenopia, difficulties in nearwork, and for concentration. Differential diagnosis must be done between dyslexia, non refractive accommodative esotropia with high AC/A. In some cases we can't exclude the possibility of myasthenia even if this subject is still in discussion. The authors report two clinical cases of hypoaccommodation in children.

Adjustable-suture strabismus surgery.

The indications and details of the adjustable strabismus surgery technique are described. General anaesthesia with adjustment in the immediate postoperative period as well as topical anaesthesia surgery were used. The results are discussed (56 patients).