Orbital
Disease
Orbital
Disease
Present Status and
Future Challenges
edited by
Jack Rootman
Boca Raton London New York Singapore
Published in 2005 by Taylor & Francis Group
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Contents
Introduction . . . . xi
Contributors . . . . xiii
ORBITAL INFLAMMATORY DISEASE
1.Orbital Inflammatory Disease: Classification and New Insights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Jack Rootman
Definition, Classification, and Changing Paradigm in Orbital Inflammatory Disease . . . . 2
Role of Biopsy . . . . 2
The Role of Immune Mediators in Specific Inflammations . . . . 8
Changing Paradigms in the Treatment of Inflammation: The Rheumatologic Approach . . . . 9
Directed Treatments of Distinct Orbital Inflammations . . . . 9
2.Changing Paradigms in the Treatment
of Inflammatory Disorders . . . . . . . . . . . . . . . . . 15
Kam Shojania
Abstract . . . . 15
iii
iv |
Contents |
3.Bacterial Infections of the Orbit: Current Status and Future Challenges . . . . . . . . . . . . . . . . . . . . 25
Gerald J. Harris
4.Inflammation: Definitions, Regulatory Mechanisms,
and Contributions to Disease . . . . . . . . . . . . . . |
33 |
Bruce M. McManus and Jonathan C. Choy |
|
5.Future and Emerging Treatments for Microbial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Anthony W. Chow
Challenges in the Treatment of Infections . . . . 45
Microbiologic Diagnosis . . . . 46
New Antimicrobials and Pharmacologic Principles of
Antimicrobial Therapy . . . . 51
Emerging Antibiotic Resistance . . . . 55
ONCOLOGY
6.The Science and Value of Lymphoma Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Randy D. Gascoyne
Historical Perspective . . . . 65
Current Approach . . . . |
71 |
Lymphomas of the Ocular Adnexa and Eye . . . . 72 |
|
Future Directions . . . . |
74 |
7.Non-Hodgkin’s Lymphoma . . . . . . . . . . . . . . . . . 77
Joseph M. Connors
Incidence and Epidemiology |
. . . . 77 |
Etiology and Risk Factors |
. . . . 78 |
Diagnosis, Classification, and Staging . . . . 80 |
|
Treatment . . . . 80
Special Comments Lymphoma Associated
with the Eye . . . . 82
8. Epithelial Lacrimal Gland Tumors: Pathologic Classification and Current Understanding . . . 87
Thomas J. Joly, Jack Rootman, Kenneth W. Berean, Valerie A. White, Hind M. Al-Katan, Sylvia Pasternak, Guilio Bonavolonta, Diego Strianese, Peerooz Saeed, Kenneth A. Feldman, Sumalee Vangveeravong, and Jocelyne S. Lapointe
Contents |
v |
9.Chemotherapy of Epithelial Lesions: New Approaches and Directions . . . . . . . . . . . . . . . . 95
James H. Goldie
Abstract . . . . 95 |
|
|
|
Introduction . . . . 96 |
|
|
|
Steps Toward Tumor Specific Therapy . . . . |
96 |
|
|
Cancer Specific Molecular Targets |
. . . . 97 |
|
|
DNA Array Analysis . . . . 100 |
|
|
|
Which Molecular Targets? . . . . |
101 |
|
|
What is the Fundamental ‘‘Cause’’ of Cancer? |
. . . . |
102 |
|
Bureaucratic Obstacles in Drug Development |
. . . . |
103 |
|
Conclusions . . . . 104 |
|
|
|
10.Malignant Lacrimal Gland Tumors . . . . . . . . . 107
George B. Bartley
11.The Management of Optic Nerve Sheath
and Sphenoid Wing Meningiomas . . . . . . . . . . 117
John S. Kennerdell, Kimberly P. Cockerham, Roger E. Turbin, and Joseph C. Maroon
Therapeutic Recommendations . . . . 120 Sphenoid Wing Meningiomas . . . . 123
12. Gliomas of the Anterior Visual Pathway . . . . 129
Jonathan J. Dutton |
|
Clinical Characteristics . . . . |
130 |
Presenting Signs and Symptoms |
. . . . 131 |
Radiographic Imaging . . . . 131 |
|
Ultrasound . . . . 133 |
|
Histopathology . . . . 135 |
|
Treatment and Prognosis . . . . |
136 |
13.Stereotactic Radiotherapy for Optic Nerve
and Meningeal Lesions . . . . . . . . . . . . . . . . . . . 139
Roy Ma
Background . . . . 139
Definitions . . . . 140
Methods of Stereotactic Radiation Therapy . . . . 140
Future Developments . . . . 146
Summary . . . . 146
vi |
Contents |
THYROID ORBITOPATHY
14.Pathogenesis of Graves’ Ophthalmopathy . . . 147
Colum A. Gorman
Abstract . . . . 147 Introduction . . . . 148
How are the Clinical Features of Graves’
Ophthalmopathy Evoked? |
. . . . |
148 |
Consequences of Swelling |
|
|
in the Retrobulbar Space |
. . . . |
149 |
Consequences of Restricted Extraocular Muscle Motion . . . . 149
What Measurements Reflect the Underlying Pathology in Graves’ Ophthalmopathy? . . . . 150
Why do Gags Accumulate in the Orbit in Graves’ Disease? . . . . 150
Is Graves’ Ophthalmopathy Definitely an Autoimmune Disease? . . . . 151
Could Graves’ Orbitopathy Be an Infectious Disease? . . . . 152
15.Thyroid-Associated Ophthalmopathy: Principal Antigens and Significance of Corresponding Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Ian Epstein, Donald Smallman, Stephen Baker, Kate Lazier, Jack R. Wall, and Mario Salvi
Abstract . . . . 157
Introduction . . . . 159
Clinical Subjects and Methods . . . . 160
Results . . . . 162
Discussion . . . . 165
16.Phenotypic Attributes of Orbital Fibroblasts Underlie Their Susceptibility in Graves’
Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Terry J. Smith
Complex Activities of Human Fibroblasts are Generally Underappreciated . . . . 170
Orbital Fibroblasts are Comprised of Discrete Subpopulations of Cells . . . . 171
Contents vii
Orbital Fibroblasts Synthesize High Levels of PGE2 When Treated with Proinflammatory
Cytokines . . . . 172
Proinflammatory Cytokines Enhance Hyaluronan Synthesis in Orbital Fibroblasts . . . . 173
Orbital Fibroblasts Display Cell-Surface CD40 and Respond to CD154 . . . . 175
Fibroblasts from Several Anatomic Regions Can Express
the Thyrotropin Receptor |
. . . . 176 |
|
Conclusions . . . . 177 |
|
|
17. Somatostatin Analogs in Ophthalmic and Orbital |
||
Disease: A Rationale for Their Use . . . . . . . . . |
183 |
|
Steven E. Katz, Marko I. Klisovic, Martin Lubow, and |
||
Dino D. Klisovic |
|
|
Introduction . . . . 183 |
|
|
Intraocular Tissues . . . . |
186 |
|
Extraocular Muscles and Orbital Fibrocytes . . . . |
192 |
|
Choroid Plexus and Arachnoid Granulations . . . . |
193 |
|
18.Predictors of Disease Severity in Thyroid-Related Orbitopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Peter J. Dolman, Jack Rootman, and Jugpal Arneja
Introduction . . . . 203 Methods . . . . 204 Results . . . . 205 Discussion . . . . 209
19. Prognostic Factors . . . . . . . . . . . . . . . . . . . . . . |
213 |
Claudio Marcocci, Michele Marino`, Roberto Rocchi, |
|
Barbara Mazzi, Francesca Menconi, Eugenia Morabito, |
|
Aldo Pinchera, and Luigi Bartalena |
|
20.Relationship Between Thyroid Disorders and Orbitopathy, Including Management
Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Wilmar M. Wiersinga
Graves’ Hyperthyroidism and Graves’ Ophthalmopathy: One or Two Disease Entities? . . . . 224
viii Contents
Genetic and Environmental Factors Involved in Phenotypic Appearance of Graves’ Disease . . . . 226
Influence of Thyroid Function on Graves’ Ophthalmopathy . . . . 227
Effect of Antithyroid Drugs, Thyroidectomy, and Radioactive Iodine on Graves’ Ophthalmopathy . . . . 228
Prevention of Graves’ Ophthalmopathy by Earlier Diagnosis and Treatment of Graves’ Hyperthyroidism? . . . . 231
21.Monitoring Activity of Graves’
Ophthalmopathy . . . . . . . . . . . . . . . . . . . . . . . . 237
Wilmar M. Wiersinga
Clinical Utility of Measuring Disease Activity in Graves’ Ophthalmopathy . . . . 237
Methods to Assess Disease Activity in Graves’
Ophthalmopathy . . . . 240 |
|
|||
Clinical Activity Score |
. . . . 240 |
|
||
Orbital Echography . . . . |
241 |
|
||
Orbital Octreoscan |
. . . . |
242 |
|
|
Orbital Magnetic Resonance Imaging |
. . . . 243 |
|||
Urinary Glycosaminoglycans . . . . |
244 |
|||
Serum Cytokines |
. . . . |
245 |
|
|
Serum Thyroid Stimulating |
|
|
||
Immunoglobulins . . . . 246 |
|
|||
Conclusion . . . . |
246 |
|
|
|
22.VISA Classification for Thyroid-Related Orbitopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Peter J. Dolman and Jack Rootman
Background . . . . 253
VISA Classification . . . . 254 Individual Section
Measurements . . . . 254 Discussion . . . . 258
Contents |
ix |
23. Current Medical Management |
|
of Thyroid Orbitopathy . . . . . . . . . . . . . . . . . . |
261 |
Claudio Marcocci, Michele Marino`, Roberto Rocchi, |
|
Barbara Mazzi, Francesca Menconi, Eugenia Morabito,
Aldo Pinchera, and Luigi Bartalena
Introduction . . . . 261
Nonsevere Graves’ Ophthalmopathy . . . . 262
Severe Graves’ Ophthalmopathy . . . . 262
24.Surgical Paradigms in the Management of Thyroid Orbitopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Jack Rootman
Introduction . . . . 273
Surgical Intervention During Active Orbitopathy . . . . 275
Stable Orbitopathy . . . . |
276 |
Eye Muscle Surgery . . . . |
280 |
Lid Procedures . . . . 281 |
|
25. Graves’ Orbitopathy: New and Future
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Michael Kazim
Pathophysiology of the Disease . . . . 286
Medical Therapy . . . . 289
Improvements in Orbital Decompression |
. . . . 293 |
Improvements in Eyelid Surgery . . . . |
294 |
Strabismus Surgery . . . . 294 |
|
26.Management Controversies and Preferences in Thyroid Orbitopathy: Panel Discussion
and Question Period |
. . . . . . . . . . . . . . . . . . . . 301 |
Jack Rootman and Frank Buffam |
|
Panelists’ Presentations |
. . . . 302 |
Question and Answer Session . . . . 310
VASCULAR INTERVENTION
27. A New Technique in Managing Distensible Venous
Vascular Malformations of the Orbit |
. . . . . . . 321 |
Thomas R. Marotta, Douglas A. Graeb, and Jack Rootman |
|
Introduction . . . . 321 |
|
Classification of Orbital Vascular Lesions |
. . . . 322 |
x |
|
Contents |
Anatomy of Orbital Region Venous Structures |
||
and Relationship with DVVMs . . . . |
322 |
|
Clinical Manifestations of DVVMs . . . . |
324 |
|
Investigation of DVVMs . . . . |
325 |
|
Options for Treatment with Emphasis on New |
||
Technique . . . . 330 |
|
|
Results and Complications of Treatment |
. . . . 332 |
|
Future Considerations . . . . |
332 |
|
Conclusion . . . . 333 |
|
|
28.Vascular Intervention: Current and Future Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Alan A. McNab |
|
|
|
|
Introduction . . . . 335 |
|
|
|
|
Carotid-Cavernous Sinus Fistulas . . . . 336 |
|
|||
Arteriovenous Malformations . . . . |
345 |
|
||
Distensible Venous Anomalies . . . . |
345 |
|
||
Preoperative Embolization of Tumors |
. . . . 347 |
|||
Aneurysms . . . . 349 |
|
|
|
|
Future Directions |
. . . . |
349 |
|
|
THE FUTURE |
|
|
|
|
29. The Future of Imaging in Orbital Disease |
. . . 353 |
|||
Wieslaw L. Nowinski |
|
|
|
|
Abstract . . . . 353 |
|
|
|
|
Introduction . . . . 354 |
|
|
|
|
Technological Advancements . . . . |
354 |
|
||
Human Body Models . . . . 361 |
|
|
||
Present Computer-Aided Surgery |
|
|
||
and Simulation |
. . . . |
362 |
|
|
Future Computer-Aided Orbital Surgery . . . . |
364 |
|||
Summary . . . . |
366 |
|
|
|
30.The Future of Orbital Surgery . . . . . . . . . . . . . 371
Robert Alan Goldberg
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381