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Timothy J. Mcculley - One of the best experts on this subject based on the ideXlab platform.

Rathie Rajendram - One of the best experts on this subject based on the ideXlab platform.

  • orbital radiotherapy for adult Thyroid Eye Disease
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Rathie Rajendram, Catey Bunce, Richard W J Lee, Ana M S Morley
    Abstract:

    Background Thyroid Eye Disease is an autoimmune inflammatory condition of the orbital and periorbital tissues. Orbital radiotherapy is an anti-inflammatory treatment used in the treatment of active Thyroid Eye Disease. It is administered as an outpatient procedure in 10 to 12 fractionated doses. Objectives To assess the effectiveness and adverse events of orbital radiotherapy in Thyroid Eye Disease. The effectiveness was dependent on the level of 'success' of the intervention predefined in each randomised controlled trial (RCT). Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 2), MEDLINE (January 1950 to March 2012), EMBASE (January 1980 to March 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to March 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not restrict the electronic searches for trials by date or language. We last searched the electronic databases on 12 March 2012. We screened reference lists of reports of included studies, other reviews and book chapters to find additional trials. We contacted trial investigators and experts in the field to identify additionally published studies. Selection criteria We included RCTs of orbital radiotherapy versus sham radiotherapy or other interventions enrolling adults, with a minimum of three months' follow-up and an endpoint of two years or less post treatment. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Trial authors were contacted for missing data. The risk ratio was used for our primary outcome. For our secondary outcomes, the odds ratio and mean difference were reported where possible. Main results We obtained full-text copies of nine potential studies and included five trials with a total of 244 participants in this review. Orbital radiotherapy was compared to sham radiotherapy in two studies and to glucocorticoids in three studies, as a monotherapy or combination therapy. There was heterogeneity (as defined in our protocol) of trial outcome measures. Our primary outcome of a composite score was used in the two trials comparing radiotherapy versus sham radiotherapy and showed a risk ratio of success of 1.92 (95% confidence interval (CI) 1.27 to 2.91) in favour of orbital radiotherapy. The primary outcome was not used in the other three trials. Authors' conclusions This review found that orbital radiotherapy is more effective than sham radiotherapy for the treatment of mild-to-moderate Thyroid Eye Disease. In a single trial no difference between radiotherapy and steroid monotherapy was found. A meta-analysis of our secondary outcome of Disease severity was not possible but results from individual trials suggest a better outcome with combination treatment with steroids versus steroids alone. No significant changes in quality-of-life scores following treatment with radiotherapy versus alternative treatments were found. Short-term adverse events related to radiotherapy that were reported were local and mild but long-term data were lacking and development of retinal changes following radiotherapy was not reported on.

  • Smoking and strabismus surgery in patients with Thyroid Eye Disease.
    Ophthalmology, 2011
    Co-Authors: Rathie Rajendram, Gillian G.w. Adams, Colin M. Dayan, Catey Bunce, G E Rose
    Abstract:

    Objective To investigate the relationship between smoking status at presentation and the use of strabismus surgery in the management of patients with Thyroid Eye Disease. Design Retrospective review of a noncomparative series of patients with Thyroid Eye Disease. Participants All patients with Thyroid Eye Disease under the care of a single consultant at Moorfields Eye Hospital between 1997 and 2002 (inclusive). Methods Retrospective review of clinical case notes. Main Outcome Measures Survival analysis of patients in cohort and the frequency of strabismus surgery in relation to smoking status at ophthalmic presentation. A subanalysis of patients who underwent orbital decompression and those that did not was undertaken. Results Of 501 patients seen during the study period, 425 (85%) of 501 sets of notes were available for review, and initial smoking status was recorded for 89% (378/425) of patients, of whom approximately one half (196/378; 52%) were active smokers. Of the smokers, 51 (26%) of 196 underwent strabismus surgery, compared with only 19 (14%) of 138 nonsmokers at presentation. When adjusted for age, the hazards ratio of having strabismus surgery during management for smokers at presentation versus nonactive smokers was 2.19. In the group who did not undergo orbital decompression, this hazard ratio increased to 4.86. Conclusions Within this Thyroid Eye Disease cohort, the proportion of smokers at presentation was much larger than that of the general population. There was an increased use of strabismus surgery in active smokers at presentation than in nonactive smokers. This finding was independent of the orbital decompression surgery. The results are consistent with those of previous reports of more severe Thyroid Eye Disease in smokers and raise the possibility that smoking cessation early in the Disease may reduce the severity of the changes and the number of rehabilitative strabismus operations needed. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Catey Bunce - One of the best experts on this subject based on the ideXlab platform.

  • orbital radiotherapy for adult Thyroid Eye Disease
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Rathie Rajendram, Catey Bunce, Richard W J Lee, Ana M S Morley
    Abstract:

    Background Thyroid Eye Disease is an autoimmune inflammatory condition of the orbital and periorbital tissues. Orbital radiotherapy is an anti-inflammatory treatment used in the treatment of active Thyroid Eye Disease. It is administered as an outpatient procedure in 10 to 12 fractionated doses. Objectives To assess the effectiveness and adverse events of orbital radiotherapy in Thyroid Eye Disease. The effectiveness was dependent on the level of 'success' of the intervention predefined in each randomised controlled trial (RCT). Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 2), MEDLINE (January 1950 to March 2012), EMBASE (January 1980 to March 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to March 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not restrict the electronic searches for trials by date or language. We last searched the electronic databases on 12 March 2012. We screened reference lists of reports of included studies, other reviews and book chapters to find additional trials. We contacted trial investigators and experts in the field to identify additionally published studies. Selection criteria We included RCTs of orbital radiotherapy versus sham radiotherapy or other interventions enrolling adults, with a minimum of three months' follow-up and an endpoint of two years or less post treatment. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Trial authors were contacted for missing data. The risk ratio was used for our primary outcome. For our secondary outcomes, the odds ratio and mean difference were reported where possible. Main results We obtained full-text copies of nine potential studies and included five trials with a total of 244 participants in this review. Orbital radiotherapy was compared to sham radiotherapy in two studies and to glucocorticoids in three studies, as a monotherapy or combination therapy. There was heterogeneity (as defined in our protocol) of trial outcome measures. Our primary outcome of a composite score was used in the two trials comparing radiotherapy versus sham radiotherapy and showed a risk ratio of success of 1.92 (95% confidence interval (CI) 1.27 to 2.91) in favour of orbital radiotherapy. The primary outcome was not used in the other three trials. Authors' conclusions This review found that orbital radiotherapy is more effective than sham radiotherapy for the treatment of mild-to-moderate Thyroid Eye Disease. In a single trial no difference between radiotherapy and steroid monotherapy was found. A meta-analysis of our secondary outcome of Disease severity was not possible but results from individual trials suggest a better outcome with combination treatment with steroids versus steroids alone. No significant changes in quality-of-life scores following treatment with radiotherapy versus alternative treatments were found. Short-term adverse events related to radiotherapy that were reported were local and mild but long-term data were lacking and development of retinal changes following radiotherapy was not reported on.

  • Smoking and strabismus surgery in patients with Thyroid Eye Disease.
    Ophthalmology, 2011
    Co-Authors: Rathie Rajendram, Gillian G.w. Adams, Colin M. Dayan, Catey Bunce, G E Rose
    Abstract:

    Objective To investigate the relationship between smoking status at presentation and the use of strabismus surgery in the management of patients with Thyroid Eye Disease. Design Retrospective review of a noncomparative series of patients with Thyroid Eye Disease. Participants All patients with Thyroid Eye Disease under the care of a single consultant at Moorfields Eye Hospital between 1997 and 2002 (inclusive). Methods Retrospective review of clinical case notes. Main Outcome Measures Survival analysis of patients in cohort and the frequency of strabismus surgery in relation to smoking status at ophthalmic presentation. A subanalysis of patients who underwent orbital decompression and those that did not was undertaken. Results Of 501 patients seen during the study period, 425 (85%) of 501 sets of notes were available for review, and initial smoking status was recorded for 89% (378/425) of patients, of whom approximately one half (196/378; 52%) were active smokers. Of the smokers, 51 (26%) of 196 underwent strabismus surgery, compared with only 19 (14%) of 138 nonsmokers at presentation. When adjusted for age, the hazards ratio of having strabismus surgery during management for smokers at presentation versus nonactive smokers was 2.19. In the group who did not undergo orbital decompression, this hazard ratio increased to 4.86. Conclusions Within this Thyroid Eye Disease cohort, the proportion of smokers at presentation was much larger than that of the general population. There was an increased use of strabismus surgery in active smokers at presentation than in nonactive smokers. This finding was independent of the orbital decompression surgery. The results are consistent with those of previous reports of more severe Thyroid Eye Disease in smokers and raise the possibility that smoking cessation early in the Disease may reduce the severity of the changes and the number of rehabilitative strabismus operations needed. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

P A R Meyer - One of the best experts on this subject based on the ideXlab platform.

  • Avoiding surgery for Thyroid Eye Disease.
    Eye, 2006
    Co-Authors: P A R Meyer
    Abstract:

    In Thyroid Eye Disease, autoimmune inflammation of orbital musculature\nand fat increases the bulk of the orbital contents. Orbital tension\nrises and patients stratify according to the ease with which their\nglobes can proptose. Restriction of proptosis is associated with\noptic nerve compression and visual loss; exophthalmos, with corneal\ndamage. Ocular motility is affected, initially by muscle inflammation;\nlate in the Disease, by fibrosis. Extraocular factors, including\nThyroid endocrine disturbance, antigen release, infections, malignancies,\nand smoking, may trigger and drive the orbital myopathy.The management\nof Thyroid Eye Disease by the identification and treatment of drives,\nfollowed by immunomodulatory therapy, is discussed. Fourteen patients\nwith compressive optic neuropathy were treated with immunomodulation\nusing intravenous methylprednisolone, oral prednisolone, and cyclosporin\nA, and followed up for a minimum of three years. All recovered their\npre-morbid visual acuities and visual fields in both Eyes. Severe\ndisturbances of ocular motility also recovered in 30 patients, treated\nwith the same regime. In one subject, ocular motility normalised\nwith intravenous steroids and cyclosporin A, but no oral prednisolone.\nMorbidity from the treatment was low. Immunomodulation is a rational\nand successful method for managing optic nerve compression and disordered\nmotility in this condition.

David K Wallace - One of the best experts on this subject based on the ideXlab platform.

  • Strabismus associated with Thyroid Eye Disease.
    Current opinion in ophthalmology, 2007
    Co-Authors: Erin O Schotthoefer, David K Wallace
    Abstract:

    PURPOSE OF REVIEW: We discuss the evaluation and treatment of strabismus related to Thyroid Eye Disease with special attention to the literature published in 2006.\n\nRECENT FINDINGS: The etiology of Thyroid Eye Disease is complex, although a recent review article evaluated the causative relationship between smoking and Thyroid Eye Disease. The treatment of Thyroid Eye Disease is also complex and involves a multidisciplinary approach including endocrinology and ophthalmology. Several recent articles have evaluated the role of medications in the treatment of Thyroid Eye Disease. We discuss the current surgical strategies for the treatment of strabismus related to Thyroid Eye Disease, including the use of adjustable suture techniques. New techniques in nonadjustable surgery are also examined.\n\nSUMMARY: Strabismus related to Thyroid Eye Disease presents many challenges to the ophthalmologist. Successful treatment of strabismus is rewarding however, and has a significant impact on improving a patient's quality of life.