Open Access Case Report

Proptosis from Metastatic Thyroid Carcinoma: Case Report and Review

Ramya Yethadka, Abhishek Vijayakumar, K. L. Sharath Kumar

Ophthalmology Research: An International Journal, Page 18-23
DOI: 10.9734/OR/2014/6137

A 70 year old female presented with right sided orbital proptosis since one and half year with past history of thyroidectomy. On examination thyroid swelling was present with right orbital proptosis. Routine blood investigations were normal except the serum thyroglobulin levels, 22000I/U. Histopathological examination (HPE) of the biopsy from the protruding mass from the right orbit showed follicular acini lined with cuboidal cells. CECT (Contrast enhanced computerized tomography) of orbit showed mass in the superior part of retro orbital region eroding the superior wall and extending into right parasellar. A total thyroidectomy was performed and HPE of specimen was suggestive of thyroid papillary carcinoma. For the orbital metastasis patient underwent external beam radiotherapy with 40 Gray in 20 fractions. During her follow up period she was found to have secondary in the left femur metaphysis. Patient refused surgical excision of the bone secondary. Patient is on regular follow up with supportive treatment.


Open Access Original Research Article

Effects of Micronutrients on Serum Antioxidant Status of Glaucoma Patients: A Randomized, Placebo-controlled, Double-masked Pilot Study

Alice L. Yu, Ozana Moraru, Carl Erb, Ulrich Welge-Lussen

Ophthalmology Research: An International Journal, Page 1-9
DOI: 10.9734/OR/2014/5926

Aims: Glaucoma is a chronic eye disease, which is associated with progressive optic neurodegeneration and concomitant visual field defects. Besides an elevated intraocular pressure, recent studies have suggested that other risk factors such as oxidative stress may play an important role in the pathogenesis of glaucoma. The goal of this study was to examine the effects of oral micronutrients on the antioxidant status in glaucoma patients.

Study Design: randomized, placebo-controlled, double-masked pilot study.

Place and Duration of Study: Ophthalmological Clinic Oculus Parter-Bucharest, Romania, between March 2007 and February 2008.

Methodology: This study was conducted with 40 glaucoma patients receiving either oral supplementation of micronutrients containing 150 mg α-lipoic acid, 36 mg vitamin E, 70 mg vitamin C, 3.6 mg vitamin B1, 5 µg vitamin B12, and 100 mg bilberry extract (Ocuvite® Glaukom) or placebo tablets for a duration of six months. Effects of oral micronutrients on uric acid, ascorbic acid, and tocopherol serum concentrations were investigated in a subgroup of 25 patients. The safety of the supplementation was assessed in 40 patients.

Results: Supplementation with oral micronutrients for six months showed a minor increase of antioxidant serum levels without statistical significance (uric acid: P = 0.14; ascorbic acid: P = 0.11; tocopherol: P = 0.32). Safety data were satisfactory.

Conclusion: There were no statistically significant differences between both treatment groups, which may be explained by the short study period and the small sample size. Further extensive studies are required to verify the hypothesis that oral supplementation of micronutrients may influence the antioxidant status in glaucoma patients.


Open Access Original Research Article

Vitamin D Deficiency may be a Risk Factor for Ophthalmopathy in Patients with Graves’ Hyperthyroidism But Not Hashimoto's Thyroiditis

Hooshang Lahooti, Bryan Wise, H. Tjiang, Bernard Champion, Jack Wall

Ophthalmology Research: An International Journal, Page 10-17
DOI: 10.9734/OR/2014/4795

Aims: Apart from its key role in bone metabolism vitamin D plays a role in immune function, cancer prevention and autoimmunity induction. Vitamin D insufficiency (25-50 nmol/L) and deficiency (serum level < 25 nmol/L) are very common in the West Sydney and Blue Mountains areas of Australia. Vitamin D deficiency may also play a role in the development of ophthalmopathy in patients with thyroid autoimmunity.

Methods: We have studied a possible relationship between serum vitamin D level and ophthalmopathy in patients with Graves’ disease and Hashimoto`s thyroiditis. We studied 37 patients with Graves’ disease and 69 with Hashimoto`s thyroiditis at their first clinical visit, before any vitamin D replacement.

Results: Overall, 70% of patients with Graves’ disease, 86% of those with Hashimoto`s thyroiditis and 88% of patients with Multi nodular goiter control group were vitamin D deficient or insufficient. Sixty-one % of Graves’ patients who were vitamin D deficient and 75% of those who were vitamin D insufficient had ophthalmopathy, defined as a NOSPECS class of two or more, compared to only 27% of patients who were vitamin D replete, this difference was significant by odds ratio [5.03 (confidence interval 1.06 – 23.8) P=0.03] and showed a trend to significance by X2 test (P = 0.08). Thirty nine % of Graves’ patients who were vitamin D deficient and 25% of those who were vitamin D insufficient had no ophthalmopathy, compared to 73% of patients who were vitamin D replete.  Eleven % of patients with Hashimoto`s thyroiditis who were vitamin D deficient and 22% of those who were vitamin D insufficient had ophthalmopathy, which was generally mild and often manifest as isolated upper eyelid retraction, compared to 20% of patients who were vitamin D replete, which was not significant. There was no close correlation between vitamin D status and either the activity or severity of the ophthalmopathy, for either Graves’ disease or Hashimoto’s thyroiditis.

Conclusions: Vitamin D deficiency is significantly associated with ophthalmopathy in patients with Graves’ hyperthyroidism but not Hashimoto’s thyroiditis. The finding that a normal serum vitamin D level was associated with a decreased prevalence of ophthalmopathy in patients with Graves’ hyperthyroidism, but not Hashimoto’s thyroiditis, suggests that the pathogenesis of the eye changes in the two disorders may be different. It appears that Graves’ patients with ophthalmopathy have a greater propensity to vitamin D deficiency as compared to Graves’ patients without ophthalmopathy. While the significance of the findings needs to be addressed in a prospective study it seems that vitamin D deficiency is another risk factor for ophthalmopathy in patients with Graves` hyperthyroidism.


Open Access Original Research Article

Perimetry Comparisons for Octopus G Top and Dynamic Programmes versus Humphrey 24-2 SITA Fast and SITA Standard Programmes

Fiona J. Rowe, Manijeh Wishart, Sarah Spencer

Ophthalmology Research: An International Journal, Page 24-42
DOI: 10.9734/OR/2014/7073

Aims: Previous comparisons of Octopus and Humphrey threshold programmes have shown differences, particularly for depth of defects. Recent developments have altered the Octopus background illumination. Thus, we sought to determine the subsequent extent of differences in results from commonly used central static programmes using Octopus and Humphrey perimeters.

Study Design: Diagnostic accuracy study.

Place and Duration of Study: Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, between June 2009 and July 2012.

Methodology: We utilised Octopus G-TOP or G-dynamic programmes and Humphrey 24-2 SITA fast or standard programmes. Poor reliability was taken as errors >25%. Comparison was made for global indices (mean sensitivity, mean deviation, pattern standard deviation/loss variance), test duration from each perimeter using unpaired t tests, and Bland Altman plots for correlation of individual differences between perimeters. Clinical agreement for presence/absence of visual field loss was determined by independent assessment of results by two authors (kappa test).

Results: Eighty patients (159 eyes) were recruited. 38 eyes were excluded due to poor reliability. 34 patients (55 eyes) underwent fast static visual field assessment: 17 males and 17 females with a mean age of 63 years (SD 14). 38 patients (64 eyes) underwent standard static visual field assessment: 18 males and 20 females with a mean age of 65 years (SD 13). For both full and fast perimetry, both perimeters showed good agreement for inter observer comparison (K=0.5-0.6). SITA standard perimetry showed a higher mean sensitivity value (+2.5dB±1.0) and SITA fast perimetry showed a higher mean sensitivity value (+3.4dB±1.1) than Octopus values. Bland-Altman analysis showed increasing variability with increasing severity of defect indicating a lack of correlation for moderate to severe visual field results.

Conclusions: Visual field results were comparable for mild defects. Octopus perimetry continues to show greater defect size where there is more extensive visual field loss relating to the different strategies used by both perimeters.


Open Access Original Research Article

Technique Based on Cuckoo’s Search Algorithm for Exudates Detection in Diabetic Retinopathy

Srishti .

Ophthalmology Research: An International Journal, Page 43-54
DOI: 10.9734/OR/2014/5877

A new metaheuristic scheme based upon Cuckoo Search algorithm for the exudates detection in diabetic retinopathy using multi-level thresholding is presented in this paper. The proposed method is applied for edge detection and the results obtained by this method were compared with the existing methods. This manuscript describes a new computational approach to detect exudates in fundus images using Cuckoo Search algorithm. Results illustrated by this method have a better accuracy when compared with Otsu’s and Kapur’s method. This study will be of interest to ophthalmology as automated image processing could serve as an objective evaluation of retinal disease condition.