Jarušaitienė, Dalia

Graves’ ophthalmopathy is associated with a reduced blinking frequency, eyelid retraction, proptosis, incomplete eyelid closure. Smoking significantly increases the incidence and severity of GO in patients with Graves’ disease Objective: To assess the influence of smoking on the development of dry eyes in patients with Graves’ ophthalmopathy (GO) and to determine the properties of tear secretion and ocular surface in these patients. Methods: A cross-sectional study was conducted at the outpatient department of the Eye Diseases Clinic of the Lithuanian University of Health Sciences. The study included 52 patients with a mean age of 47.3 (17.4–69.6) years. The study included 25 smokers and 27 non-smokers with Graves’ ophthalmopathy (a total of 52 patients). Their mean age was 47.3 (17.4–69.6) years. Patients underwent ophthalmological examination, ocular surface disease index (OSDI) assessment, Schirmer test without local anesthesia (<5 mm was abnormal), slit-lamp biomicroscopy (tear break-up time (TBUT) under blue light illumination). Statistical analysis was performed using SPSS for Windows software (SPSS Inc., Chicago, IL, USA). Statistical significance was determined at p < 0.05. Results: The mean OSDI score in smoking GO patients was significantly higher (28.79 ± 15.29) compared to non-smoking patients (10.58 ± 7.41), (p < 0.05). The mean Schirmer test value in smoking GO patients was significantly lower (4.21 ± 3.07 mm) compared to non-smoking patients (11.74 ± 6.24 mm). The difference was statistically significant (p < 0.04), indicating insufficient tear production. The mean tear film breakup time (TBUT) was lower in smoking GO patients (7.04 ± 2.25 s) compared with nonsmoking patients (10.93 ± 3.12 s), ( p < 0.04), indicating an unstable tear film. Conclusion: The study found statistically significantly increased OSDI scores, shorter Schirmer scale and tear film breakup time measurements in smokers with GO. These data may indicate a predisposition to dry eye syndrome in smokers.

The aim of our study was to evaluate the features of Graves’ ophthalmopathy in juvenile Graves disease.

Objectives: To identify the signs of Graves’ ophthalmopathy in juvenile patients with Graves’ disease.

Methods: The retrospective study was done at the Lithuanian University of Health science Kaunas Clinic of Eye diseases outpatient department. We reviewed the electronic medical records of all patients with Graves‘ Disease (GD) seen at the Clinic of Eye diseases, selecting 130 total patients, the age at diagnosis of GD, patients age was 17 (4.4-29.3) years. All patients had undergone a full ophthalmologic exam, including visual acuity, CAS, exophthalmometry with Hertel mirror exophthalmometer, biomicroscopy and ophthalmoscopy.

The statistical analysis was performed using the following softtware program package „SPSS for Windows“ (SPSS Inc., Chicago, IL, USA). The level of statistical significance was set at p<0.05 for all the tests.

Results: Of the total 130 patients with GD, 92 had no evidence of Graves’ Ophthalmopathy (GO-) and 38 had Graves’ Ophthalmopathy (GO+). When comparing the development of Graves’ Ophthalmopathy in patients with Graves’ disease by gender, we found that in both (GO+ and GO-) groups, there were statistically significantly more females than males (76.3/23.7% in the GO +group and 91.3/8.7% in the GO- group, p < 0.05). The study found that 38 patients with Graves’ disease had ocular changes characteristic of Graves’ Ophthalmopathy. The most common patient’s complaints were bulging of eyes (76.3%) and symptoms which are characteristic of dry eye syndrome (eye grittiness – 42.1%, tearing – 42.1% and photophobia – 31.6%). In the Graves’ ophthalmopathy group, the most common specific signs were upper eyelid retraction (73.7%) and Graefe’s symptom (47.4%). As non-specific, clinical symptoms of activity, showing 42.1 % of cases, hyperemia of conjunctivae (42.1%), carunculal redness (23.7%) were observed. The clinically active form (CAS was more than 3 points out of 7) was observed in 8 (21.1%) GO+ patients. 8 (21.1%} patients had impaired eye movements, but eye movements were limited only to the lateral side. There were no color sensitivity disorders in GO+ patients.

Conclusion: The most common patient’s with Graves’ Ophthalmopathy complaints were bulging of eyes and symptoms which are characteristic of dry eye syndrome (eye grittiness, tearing and photophobia). In this group of patients the most common specific signs were upper eyelid retraction and Graefe’s symptom. As non-specific, clinical symptoms of Graves’ Ophthalmopathy activity were hyperemia of conjunctivae, carunculal redness.

Purpose: to determine clinical signs, retinal nerve fiber layer and central macular thickness in patients with Graves ophthalmopathy

Objectives: To determine the Clinical Activity Score, best visual acuity, intraocular pressure and exophthalmos in patients with Graves’ Ophthalmopathy. To determine Retinal Nerve Fiber Layer (RNFL) and Central Macular Thickness (CMT) by Optical Coherent Tomography (OCT). To determine the relationship between CAS, best visual acuity, intraocular pressure, exophthalmos and RNFL, central macular thickness.

Methods: The retrospective study was done at Lithuanian University of Health sciences Kaunas Clinic of Eye diseases outpatient department. We reviewed the electronic medical records of all patients with Graves‘ ophthalmopathy seen at the Clinic of Eye diseases between 2021 and 2024, selecting 62 total patients (124 eys). The median age was 49.3 years, ranging from 18.4 years to 74.5 years. All patients had undergone a full ophthalmologic exam, including Best Corrected Visual Acuity (BCVA), Clinical Activity Score (CAS), exophthalmometry with Hertel mirror exophthalmometer, dilated fundus imaging, Schiotz tonometry and OCT imaging (RNFL and CMT).

All data were processed using statistical analysis software IBM SPSS 29.0. A statistical significance level of p<0.05 was considered.

Results: The mean of CAS of patients was 3,22 ± 0.43, (range 0-7). The mean BCVA was 0.84 ± 0.19. Intraocular eye pressure ranged form 12.3 to 23.5 mmHg, with a mean of 16.83 ± 2.75 mmHg. Exophthalmos results ranged form 13.9 to 23.3 mm. The mean was 18.26 ± 2.07 mm. The mean of RNFL thickness was 96.84 ± 11.27μm and central macular thickness was 271.43± 22.82μm. A statistically significant correlation was found between BCVA and RNFL, CMT thickness (r=0.376, p=0.001, r=0.258, p=0.026, respectively). A statistically significant negative correlation was found between CAS and RNFL, CMT (r=-0.406, p<0.001; r=-0.233, p=0.046, respectively). These data indicate that the lower the visual acuity and the higher the disease activity, the thinner the RNFL and CMT.

A negative significant correlation was between IOP, exophthalmos and RNFL (r=-0.348, p=0.002; r=-0.287, p=0.013, respectively). This shows that the greater IOP and exophthalmos the thinner RNFL. However, there was no significant relationships between IOP, exophthalmos and CMT (r=-0.14, p=0.235; r=-0.2, p=0.088, respectively).

Conclusion: A statistically significant correlation was found between Clinical activity score, best corrected visual acuity, intraocular pressure, exophthalmos and RNFL in patients with GO. CAS and BCVA were significantly correlated with central macular thickness. There was no significant relationship between IOP, exophthalmos and CMT. Our study suggests that OCT is useful in diagnosing, monitoring and predicting vision in patients with compressive optic neuropathy in GO.

Įvadas. Ptozė – viršutinio voko nusileidimas žemiau įprastinės padėties (> 2 mm). Atsižvelgiant į išsivystymo laiką, ptozės skirstomos į įgytas bei įgimtas. Pastarosios dažniausiai pasireiškia vaikams, gali būti paveldimos, pasireikšti vienoje ar abejose akyse kaip izoliuotas sutrikimas arba kartu su kitomis sisteminėmis ligomis. Manoma, kad šio sutrikimo patogenezę lemia ne tik raumenų vystymosi sutrikimas, bet ir jų inervacijos pažaida. Kita vertus, šiuo metu tikslaus įgimtos vokų ptozės patogenezės apibūdinimo dar nėra. Tikslas. Pristatyti pagrindines įgimtų ptozių klinikines išraiškas tam, kad būtų pasirenkamas ankstyvas ir tikslus ligos gydymas. Medžiaga ir metodai. Literatūros apžvalga buvo atlikta „PubMed“ duomenų bazėje, naudojant terminą „įgimta ptozė“ kartu su „miogeninė įgimta ptozė“, ,,neurogeninė įgimta ptozė“ nuo 2010 – 2023 m. Į literatūros apžvalgą įtraukti straipsniai, atitinkantys paieškos kriterijus. Rezultatai. 1) Miogeninės ptozės atsiradimo mechanizmas yra susijęs su viršutinio voko keliamojo raumens vystymosi pažaida, kai raumens skaidulos pakeičiamos kitu audiniu. Jai būdingi dažniausi klinikiniai pasireiškimai: izoliuota įgimta ptozė ir blefarofimozės - ptozės - inversinio epikanto sindromas. 2) Neurogeninė įgimta ptozė atsiranda esant voko keliamųjų raumenų inervacijos sutrikimui. Jos kilmę lemia didesnė grupė ligų, priskiriamų įgimtai kaukolės inervacijos sutrikimų grupei: įgimta ekstraokulinių raumenų fibrozė, Markuso - Guno, Duano, Mebiuso sindromai, paveldima įgimta veido parezė, Hornerio sindromas bei įgimtas III galvinio nervo paralyžius. Išvados. Įgimtos ptozės etiologija įvairi, tačiau miogeninės ir neurogeninės kilmės įgimtos ptozės literatūroje aprašomos dažniausiai, o jų pasireiškimas didesnis vaikų amžiuje. Pagrindinis įgimtos ptozės etiopatogenezės mechanizmas išlieka neaiškus.

PURPOSE: The purpose of this study is to evaluate the tear secretion and ocular surface properties in children with Graves‘ ophthalmopathy (GO) and to compare the results with those of healthy children. METHODS: This was a cross sectional study. Forty three patients with GO (Group 1) and 41 healthy children without any ocular and/or systemic disorder (Group 2) were examined clinically and underwent tests for dry eye. We performed analyses including the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer‘s test under topical anesthesia (<5 mm was abnormal), slit lamp biomicroscopy (corneal fluorescein staining and tear breakup time (TBUT) under blue light illumination), and fundoscopic evaluation. RESULTS: Dry eye symptoms and the mean OSDI score were significantly (P < 0.02) higher (15.6 ± 18.7) in patients with GO compared with controls (5.67 ± 3.6). The mean Schirmer‘s (basal tear secretion) tests value was significantly reduced in Group 1 (5.25 ± 3.1 mm) compared with Group 2 (17.1 ± 5.2), respectively. The difference was statistically significant (p < 0.005), suggesting inadequate tear production. The mean tear film breakup time in children was lower in patients with GO (8.3 ± 3.42 s,) compared with controls (13.2 ± 4.74 s), (P < 0.001) suggesting an unstable tear film. Decrease of corneal sensitivity (23.3%) was noted in patients with GO compared with controls. GO patients showed a significant increase of the frequency of corneal fluorescein staining (6.9%) in patients with GO compared with controls. CONCLUSION: Patients with GO had a statistically significant higher incidence of dry eye symptoms and the increase of OSDI score. Significantly lower Schirmer‘s and TBUT tests results were seen in the study group when compared with the controls. These findings may indicate a tendency for dry eye in pediatric GO patients.

Ambliopija yra funkcinis vienos arba abiejų akių regos aštrumo sumažėjimas. Ji gali atsirasti dėl sutrikusios regos formavimosi kūdikystėje ir ankstyvoje vaikystėje be anatominių akių arba regos sistemos struktūrinių pokyčių. Ilgai buvo manoma, jog šios ligos gydymas veiksmingas tik kritiniu regos formavimosi laikotarpiu, tačiau naujausi tyrimai rodo, kad regų galima pagerinti pasibaigus kritiniam periodui, taip pat ir suaugusiam žmogui. Šiame straipsnyje apžvelgiami naujausi ambliopijos gydymo metodai tiek suaugusiesiems, tiek vaikams.

Įvadas. Skydliaukės ligų metu gali būti pažeidžiamos akys. Greivso oftalmopatija– tai lėtai progresuojantisavita autoimuninė liga, pažeidžianti už akies obuolio esančius audinius ir judinamuosius tiesiuosius akiesraumenis. Gali būti vienos ar abiejų akių pokyčiai. Būdingi požymiai: minkštųjų audinių pakitimai (vokų,junginių paburkimas, paraudimas); išverstakumas (vienpusis ar abipusis); ragenos pokyčiai (šviesos baimė,ašarojimas, akių graužimas); regos pablogėjimas (dėl regos nervo suspaudimo tiesiaisiais akį judinančiaisraumenimis); judinamųjų akies raumenų pažeidimas (judesių sutrikimas, dvejinimasis, žvairumas).Nustatyta, kad selenas padeda palaikyti normalią imuninės sistemos, normalią skydliaukės veiklą, apsaugotiląsteles nuo oksidacinės pažaidos. Pagrindinė seleno funkcija yra dalyvavimas antioksidacinėje sistemoje irskydliaukės hormonų metabolizme. Kintamojo magnetinio lauko terapija mažina akiduobės raumenų irminkštųjų audinių paburkimą, gerina kraujotaką.Tikslas - ištirti regos aštrumą, refrakcijos būklę, akių išverstakumą, sergantiems Greivso oftalmopatija, taikantseleną ir impulsinio magnetinio lauko terapiją, prieš ir po gydymo kurso.[...].

Greivso liga – tai autoimuninė liga, sukeliama daugelio priežasčių. Sergant Greivso liga, padidėja skydliaukės hormonų gamyba, taip pat gali būti stebimi akių raumenų, už akies esančio jungiamojo ir riebalinio audinių uždegiminiai ir odos (blauzdų poodinio audinio, retais atvejais dilbių arba pečių sričių) pokyčiai [1,2]. Tai yra dažniausias išorinis Greivso ligos požymis [3]. Šia liga dažniausiai serga 40-60 metų žmonės, bet ji gali būti diagnozuojama ir jaunesnio amžiaus suaugusiesiems, taip pat vaikams [4,5,6]. Vakarų šalyse Greivso liga serga 5-10 proc. gyventojų [7]. Ji nustatoma 20-40-čiai suaugusiųjų 100 000 gyventojų [8-10]. Mokomoji knyga skirta studentams, rezidentams ir gydytojams, taip pat kaip papildoma II-III k. studijų modulių "Nervinė ir endokrininė reguliacija", "Medžiagų apykaita" literatūra.

The majority of young adults disease have symptoms of ocular dryness, epiphora, photophobia, stinging. Dry eye symptoms may coincide and most of the time they appear separately and present differently. Usually a careful history and exam is required in order to determine which condition is present. Aim - To evaluate the ocular dryness signs in young adults. Methods. This study included randomly selected 58 youing adults. An average age of patients was 25.3 years old (SD 5.8). Ocular Surface Disease Index (OSDI), the mean of tear break-up time (TBUT), Schirmer‘s test (without topical anesthesia), corneal sensitivity were examined. Results. OSDI index was 31.2±6.78, the TBUT (5.72± 1.54 sec,) Schirmer‘s tests value (6.62± 3.16 mm) were reduced, the increase of the frequency of corneal fluorescein staining (20.7 %), and decrease of the frequency of corneal sensitivity (13.8 %) were noted in patients with TAO compa-red with controls. Conclusion. The TBUT, Schirmer‘s tests values were reduced, the increase of the frequency of corneal fluorescein staining and decrease of the frequency of corneal sensitivity were observed in young adults.

Kogano sindromas - tai reta, autoimuninė, multisisteminė liga, kuri skirstoma į tipinę ir atipinę formas. Sindromas dažniausiai pažeidžia regos, klausos ir pusiausvyros organus. Kliniškai ši liga pasireiškia abipusiu intersticiniu keratitu, uveitu, konjunktyvitu, skleritu, episkleritu, tinklainės vaskulitu, neurosensoriniu klausos praradimu, pusiausvyros sutrikimu ir tinitu. Patogenezė nėra pakankamai ištirta, tačiau daugėja įrodymais pagrįstų tyrimų, kurie siejami su autoimuniniu organizmo atsaku. Kogano sindromo diagnostika remiasi klinikine išraiška, antigeno-antikūno sąveikos nustatymu laboratoriniuose tyrimuose, šių dienų pagrindinis rekomenduojamas gydymas yra kompleksinė terapija skiriant steroidus ir imunosupresinius medikamentus kartu. Siekiant pagerinti paciento gyvenimo kokybę, esant klausos sutrikimui, implantuojamas kochlearinis implantas.