Objective To evaluate the effectiveness and safety of orbital decompression for compressive optic-neuropathy. Methods Fourteen eyes of twelve cases with Graves opthalmopathy and compressive optic-neuropathy undergone two orbital walls decompression with the follow-up period of more than 3 months were analyzed. Results The effect of complete closure of palpebral fissure was attained in all of the postoperative eyes and the visual acuity was increased in eleven eyes, remained no change in two eyes and decreased in one eye. The mean value of the recession of exophth almic eyes after operation was mean 4.0 mm. Conclusion Two or bital walls decompression is an effective method for compressive optic-neuropathy in Gaves ophthalmopathy. (Chin J Ocul Fundus Dis, 2001,17:303-304)
Immunoglobulin G4-related disease (IgG4-RD) is a new disease entity recognized at the start of this century noted to be involving many organ systems including endocrine system and thyroid in particular. It represents an immune mediated fibro inflammatory condition with characteristic histopathological appearance affecting single or multiple organs. In general, immunoglobulin G4-related thyroid disease (IgG4-RTD) is rarely considered and it may be isolated or with other organ involvement. Four subcategories of IgG4-RTD have been identified so far: Riedel thyroiditis, fibrosing variant of Hashimoto thyroiditis, immunoglobulin G4-related Hashimoto thyroiditis, and Graves disease with elevated immunoglobulin G4 levels. The diagnostic approach is complex and the work up relies on the coexistence of clinical features, histological features and serological evidence. Demonstration of the classic histopathological features is vital to diagnose IgG4-RD in most cases, and biopsy proof is preferred strongly by most disease experts before the initiation of treatment. The treatments for IgG4-RTD include medical and surgical options. Steroids are first line treatment though it may need further evaluation. Tamoxifen and rituximab are second line treatment for steroid resistant patients. Surgical excision of thyroid gland in presence of compression symptoms is the surgical option. Inspite of pathophysiology of the disease being poorly understood till now, early and prompt diagnosis and an early treatment initiation can improve the outcomes.