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Background: Increasing evidence has indicated that the entire visual pathway from retina to visual cortex may be involved in dysthyroid optic neuropathy (DON) pathological mechanisms. Purpose: To explore the functional and morphological brain characteristics in DON and their relationship with ophthalmologic performance. Study Type: Retrospective. Population: A total of 30 DON patients, 40 thyroid‐associated ophthalmopathy (TAO) without DON patients and 21 healthy‐controls (HCs). Field Strength/Sequence: A 3.0 T, 3D T1‐weighted spoiled gradient‐recalled echo and gradient‐recalled echo‐planar imaging. Assessment: Functional and structural alterations in brain regions were evaluated with fractional amplitude of low‐frequency fluctuations, degree centrality (DC), and gray matter volume (GMV). Clinical activity score (CAS) is assessed across patients. Statistical Test: One‐way analysis of variance with post hoc two sample t‐tests (GRF‐corrected, voxel level: P < 0.005, cluster level: P < 0.05) and correlation analysis (significance level: P < 0.05). Results: Compared to HCs, DON patients had significantly decreased DC values in the bilateral BA17 and BA18 regions. Compared to the TAO group, DON patients had decreased GMV in the left anterior cingulate cortex, left middle frontal gyrus, left lingual gyrus, left parietal gyrus, right Rolandic operculum, left supplementary motor area, and right middle temporal gyrus. In addition, GMV in the right Rolandic operculum was significantly positively correlated with CAS (correlation coefficient: r = 0.448). Data Conclusion: This study showed significant morphological and functional alterations in visual cortex and morphological alterations in partial default mode network regions of DON patients, which may provide insights into the mechanism of vision loss and may facilitate the diagnosis and treatment of DON. Evidence Level: 3. Technical Efficacy: Stage 3. [ABSTRACT FROM AUTHOR]

Background: The mechanism driving dysthyroid optic neuropathy (DON) is unclear. Diffusion‐tensor imaging (DTI) allows for noninvasively assessing the microstructure of the entire visual pathway and may facilitate a better understanding of the mechanism of DON. Purpose: To assess microstructural changes of the whole visual pathway and to investigate the potential mechanism of trans‐synaptic damage（TSD） pathogenesis in DON with DTI. Study Type: Cross‐sectional. Population: Sixty‐four patients with bilateral thyroid‐associated ophthalmopathy (TAO), 30 with and 34 without DON, and 30 age‐ and sex‐matched healthy controls (HCs). Field Strength/Sequence: 3 T/DTI (A single‐shot diffusion‐weighted echo‐planar imaging sequence). Assessment: Differences in DTI parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in each segment (optic nerve, tract, and radiation) of the entire visual pathway among the groups were compared. The parameters of visual evoked potentials (VEPs), visual field tests, and mean retinal nerve fiber layer (mRNFL) thickness on optical coherence tomography were also compared across patients. Statistical Tests: Student's t‐test, chi‐square test; ANOVA with post‐hoc testing, interclass correlation coefficient, and correlation analysis. Significance level: P < 0.05. Results: TAO patients with DON showed significantly reduced mRNFL thickness and abnormal VEPs. There was a tendency for gradually reduced FA and AD, and increased RD and MD from HCs, with non‐DON to with DON in optic nerve and tract, statistically. For radiation, the RD and MD showed statistical increase, the AD and FA just showed numerical decrease (P = 0.119 and 0.059, respectively). For DON, the FA and MD of visual pathway segments showed correlations with abnormal VEPs. Data Conclusion: DTI may be a useful tool for detecting microstructural changes in the entire visual pathway in DON. The changes in RNFL thickness and DTI parameters suggested TSD as a potential pathogenic mechanism of DON. Evidence Level: 4 Technical Efficacy: Stage 5 [ABSTRACT FROM AUTHOR]

To investigate the association between serum immunoglobulin G4 (IgG4) levels and laboratorial parameters. Moreover, the ocular manifestations were compared in Graves' ophthalmopathy (GO) patients. Fifty-seven GO patients and fifty sex- and age-matched euthyroid subjects were enrolled. Serum IgG4 and immunoglobulin G (IgG) levels, thyroid hormones and thyroid autoantibodies were measured in all participants. Ophthalmologic examinations were performed to GO patients. Serum IgG4 levels were increased in GO patients compared with euthyroid subjects (p<0.001). Multivariate analysis showed that TRAb levels were correlated with IgG4 levels in GO patients (β=1.45, p = 0.024). There were eight GO patients with IgG4 levels ≥ 135 mg/dL. They all had both eyelids swelling and the differences of HER were less than 2mm. Seven patients (7/8) showed bilateral symmetrical thickening of the extraocular muscles. Bilateral symmetry of ocular manifestation was observed in GO patients with IgG4 levels ≥135 mg/dL. IgG4 levels may be helpful in monitoring GO and diagnosing a new subtype of GO. [ABSTRACT FROM AUTHOR]

Lacrimal canaliculitis (LC) is a rare infection of lacrimal passage, which is usually late diagnosed or misdiagnosed. Traditional lacrimal system tests barely provide a clear and definite understanding of the pathological changes in lacrimal passage. We presented three patients with asymptomatic and atypical symptoms who were misdiagnosed and were eventually diagnosed with chronic LC with assistance of 80‐MHz ultrasound biomicroscopy (80‐MHz UBM) and lacrimal endoscopy. To our knowledge, the mutual assistance of above two techniques diagnosing LC has never been reported, it can provide better images and observations of the canaliculus from the inside out and can guide the differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Previous study suggested IgG4 levels were associated with the development of Graves' ophthalmopathy (GO). The aims of the present study were to investigate the role of IgG4 levels in glucocorticoid (GC) treatment in GO patients. Design: 69 GO patients were enrolled. Serum thyroid hormones, thyroid antibodies, IgG, IgG4, ophthalmological examinations and orbital MRI were performed. Furthermore, the clinical outcomes (a composite response endpoint including the clinical activity score (CAS), proptosis, vision, intraocular pressure, diplopia and lid width) after high‐dose intravenous GC treatment in 32 active moderate‐to‐severe GO patients were compared. Patients: 69 consecutive patients with GO were asked to participate in the study. 32 of 69 GO patients were treated with high‐dose intravenous GCs. Measurements: Measurement of serum IgG and IgG4, serum thyroid hormones and thyroid autoantibodies. An overall ophthalmic assessment was performed pretherapy (week 0) and post‐therapy (week 12). Results: 33.3% of GO patients (23/69) had elevated IgG4 levels. IgG4 levels were positively correlated with the severity and activity of GO. After GC therapy, IgG4, IgG4/IgG, vision and CAS were significantly improved in GO patients. Patients with high IgG4 levels had a significantly reduced extraocular muscle area (EOMs) and better clinical outcomes than patients with normal IgG4 levels. Conclusions: Our results suggest a possible subgroup of elevated IgG4 GO patients, with more severe ophthalmopathy and better response to GCs treatment compare with normal IgG4 GO patients. [ABSTRACT FROM AUTHOR]

Background & objectives: Tear proteomic changes can be a candidate etiopathogenesis of lacrimal duct obstruction diseases (LDODs). Studies on proteomics have focused primarily on nasolacrimal duct obstruction, and some specific inflammatory cytokines such as interferon (IFN)-α2a, interleukin (IL)-8 and IL-10, have not been investigated. In addition, differences in inflammatory cytokines in tears according to the LDOD subtype have not been reported. This study aimed to quantitatively compare inflammatory cytokines in tears from patients with LDOD and investigate tear-cytokine differences among different LDOD subtypes. Methods: Tear samples were collected from both eyes of 30 patients with unilateral LDOD: five patients with prelacrimal obstruction, five with acute dacryocystitis and 20 with chronic dacryocystitis. The contralateral eyes were used as controls. IFN-α2a, IFN-β, IFN-γ, IL-17A, IL-6, IL-8, tumour necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF)-A, induced protein-10 (IP-10) and monocyte chemotactic protein-1 (MCP-1) were quantified in all samples. Results: The expression of eight cytokines (except for IP-10 and MCP-1) were significantly increased in the affected eyes compared with those in the control eyes. The levels of nine inflammatory cytokines (except for IP-10) in the affected eyes of patients with chronic dacryocystitis were higher than those in the affected eyes of patients with prelacrimal obstruction. In addition, patients with chronic dacryocystitis presented significantly higher IFN-γ level than those with prelacrimal obstruction or acute dacryocystitis. Interpretation & conclusions: Specific pro-inflammatory cytokines were increased in tears of patients with LDOD compared with those in the controls. The specific cytokine profiles observed in the tears of individuals with different LDOD subtypes may be associated with the unique aetiopathogenesis of these conditions. [ABSTRACT FROM AUTHOR]