Purpose: to study the morphometric parameters of the retina in patients with primary hypothyroidism and primary thyrotoxicosis by optical coherence tomography.Materials and methods. The material for this study was the results of examination of 54 patients (108 eyes) with thyroid dysfunctions: 32 people (64 eyes) with primary untreated hypothyroidism and 22 people (44 eyes) with primary untreated thyrotoxicosis. To assess the morphometric parameters of the retina, optical coherence tomography was performed.Results. A significant thickening of the layer of nerve fibers was revealed in almost all sectors of the retina of patients with primary hypothyroidism and primary thyrotoxicosis, with the exception of the upper sector in primary thyrotoxicosis. The morphometric parameters of the optic nerve head in both groups were ambiguous. With thyrotoxicosis, the diameter and topographic area of the excavation were less than normal, while the area of the neuroretinal girdle, the area and excavation of the optic nerve head, the ratio of excavation to the area of the optic nerve head, the horizontal and vertical dimensions were higher. In hypothyroidism, the diameter, area and topographic volume of the excavation, the ratio of the excavation to the area of the optic nerve head, the horizontal and vertical dimensions of the excavation to the optic nerve head were below normal, and the length and area of the neuroretinal girdle were higher. In both groups, an increase in the volume and thickness of the retina of all macula’s sectors in combination with a decrease in the minimum thickness of the fovea was revealed. A correlation between the parameters of optical coherence tomography and the rank indicators of the ratio of thyroid hormones was revealed.Conclusion. In primary hypothyroidism and primary thyrotoxicosis, statistically significant morphometric changes in the retina and optic nerve head were revealed. The morphometric data correlated with the rank indices of the thyroid hormone ratios.

Purpose : to study the prevalence and nature of visual dysfunctions in patients with primary hypothyroidism and thyrotoxicosis. Material and methods . The material for this study was the results of a survey of 54 patients (108 eyes) with thyroid dysfunctions: 32 people (64 eyes) with primary untreated hypothyroidism and 22 people (44 eyes) with primary untreated thyrotoxicosis. Static automated perimetry and dedicated shortwave infrared (blue-yellow) perimetry were performed. The average total value of the photosensitivity of each (n = 74) tested point of the field of view was analyzed, the topography of the location of focal defects was studied, and the severity of impairments to photosensitivity was assessed by aggregate signs. Results . Reliably high sensitivity (92.6 %) and specificity (50.0 %) of short-wave infrared perimetry in relation to static automated perimetry were revealed. In thyroid dysfunctions, the prevalence of optic neuropathy reaches 93 % according to the data of short-wave infrared perimetry versus 7 % of static automated perimetry. It is manifested by a diffuse decrease in light sensitivity to blue stimulus with an increase in the depth of depression from the center to the periphery in both types of thyroid dysfunction. Against this background, with primary hypothyroidism, focal defects appeared in the form of first-order scotomas, and with primary thyrotoxicosis, second-order scotomas. Scotomas were located at the periphery of the central visual field, 20–30° from the fixation point. In the analyzed groups, high average group indices of the maximum corrected visual acuity were established, which allows us to speak about the safety of the photopic (cone) component of the visual analyzer. Conclusion . The pattern of photosensitivity disorders, the topography of the location of the loci of local defects revealed by the short-wave infrared perimetry, indicate that the earliest signs of optical neuropathy are manifested at the level of photoreceptors — selectively in the S-cones. Decreased sensitivity to blue stimulus (440 nm) refers to an acquired color anomaly called tritanopia; which can be present with high visual function, is most often associated with a decrease in the number of S-cones and a deficiency of retinol (the source of cyanolab synthesis).

Purpose: to study the features of eye hydrodynamics in patients with thyroid dysfunctions.Patients and methods. The material for this study was the results of a survey of 43 patients (86 eyes) with thyroid dysfunctions: 23 people (46 eyes) with primary untreated hypothyroidism (PGT) and 20 people (40 eyes) with primary untreated thyrotoxicosis (PTT). There weren’t ophthalmic hypertension and glaucoma There weren’t signs of ophthalmic hypertension and glaucoma in the patients included in this study at the stage of primary ophthalmologic diagnostics.Results. Correlation analysis revealed a causal relationship between the ratio of T4 / TSH hormones, on the one hand, and indicators of secretion of aqueous humor per unit of time and ease of outflow, on the other hand. In the group of patients with hypothyroidism, a weak linear inverse correlation was found between the ratio of free thyroxine and thyroid stimulating hormone and the minute volume of aqueous humor: according to the regression model, an increase in the ratio of T4 / TSH hormones by 1 was accompanied by a decrease in the minute volume of aqueous humor by 3 units. In patients with thyrotoxicosis, a statistically significant inverse linear correlation was found between the ratio of the T4 / TSH hormones and the coefficient of ease of outflow. According to the regression model, with an increase in the ratio of hormones T4 / TSH by 1, the coefficient of lightness of outflow decreases by 5 units. The presence of thyroid receptors in the cytoplasm and nuclei of the endothelium cells of the trabecular apparatus, the nuclei of fibroblasts forming the stroma of the trabeculae, as well as in the nuclei of the pigment and non-pigment epithelium of the processes of the ciliary body substantiates the molecular basis of the causal connection of thyroid dysfunctions with hydrodynamic disorders The conducted studies confirm the modern concept that the control of regulation of the tissue and organ homeostasis is carried out by the coordinated interaction of 3 systems: nervous, endocrine, and immune. Regression modeling clearly shows a pronounced causal relationship between thyroid dysfunctions and hydrodynamic processes in the eye.Conclusion. The results of clinical studies demonstrate the fact of controlling regulation by hydrodynamic processes at the eye level by the endocrine system, explain the possible mechanism on a morphological basis, and reveal the potential of a new therapeutic strategy.

Purpose: to study the features of the blood filling of the eye in patients with primary untreated hypothyroidism and primary untreated thyrotoxicosis by plethysmography. Materials and methods. The material of the study was the results of a comprehensive examination of 43 patients (86 eyes): 23 people (46 eyes) with primary untreated hypothyroidism and 20 people (40 eyes) with primary untreated hyperthyroidism. The ocular blood flow was assessed by ophthalmoplethysmography. Results. The obtained plethysmography data confirm that even in the absence of endocrine ophthalmopathy in patients with primary untreated hypothyroidism and primary untreated thyrotoxicosis, deep hemodynamic disturbances in the major vessels of the eye develop leading to ischemia of its anterior and posterior parts, which can lead to hydrodynamic disturbances in the eye, sensitivity of the visual analyzer to ischemia and hypoxia and to promote the development of secondary optic neuropathy. In this study, a significant reduction of 30–40 % from the norm of volume and consumption indicators of the blood filling of the eye with impaired placement of blood in the choriocapillaries, reduced elasticity of the choroidal vessel wall was detected, which can not but trigger the development of various pathological processes. For example, ischemia of the ciliary body and the trabecular meshwork, the presence of thyroid receptors on endothelial and smooth muscle cells of choroidal and orbital vessels, can lead to hydrodynamic disturbances, and ischemia of the optic nerve, which arises due to violation peripapillary flow having choroidal source of blood supply, can result in an optical neuropathy. In this aspect, thyroid disease is associated with an increased risk of developing glaucoma, endocrine ophthalmopathy. The conclusion. Despite the constant expansion of various innovative dopplerographic systems, plethysmography — as a method of examining the blood filling of the eye, remains in demand, reliable and highly informative. In patients with uncompensated thyroid dysfunctions, a violation of the blood supply to the anterior segment of the eye is observed, which can cause a low effect of antihypertensive monotherapy in the treatment of glaucoma.

Endocrine ophthalmopathy (EOP) is a severe chronic autoimmune disease associated with autoimmune thyroid pathology that leads to loss of sight, cosmetic defects and quality of life decrease. EOP is difficult to give prognosis for due to various factors affecting its course and outcome.PURPOSE:To develop a reliable and precise prognosis method for EOP activity and severity based on personalized combination of risk factors in specific patients by multidimensional linear regression modeling.MATERIAL AND METHODS:A group of 139 patients (278 orbits) with newly diagnosed EOP associated with toxic diffuse goiter was observed during 1 year by an ophthalmologist and an endocrinologist; patient examination interval was 6 months. More than 250 indices were dynamically analyzed in the course of the study. Linear regression analysis was chosen as the research method; it allowed detection of linear dependencies between dependent and explanatory variables.RESULTS:More than 600 various linear regression equations were derived that enabled prediction of EOP onset risk and development timeline, estimation of activity and/or severity of the disease, duration of active period in specific patients for the immediate and long-term outcome. From the derived models, the most reliable and safest for practical application were picked out. The present study introduces nine optimized models that can be used for patient follow-up since day one.CONCLUSION:The onset risk, progression and outcome of the disease can be determined by a combination of factors revealed in the study.

Endocrine ophthalmopathy patients constitute a group of risk for the development of secondary open angle glaucoma (SOAG). Disrupted blood circulation in the main vessels of the eye and the orbit is a mechanism triggering eye hypertension. Purpose: To assess quantitatively the eye blood flow in patients with SOAG developed after endocrine ophthalmopathy. Material and Methods. 48 eyes of SOAG patients averagely aged 42±2.3 years were examined. SOAG, combined with endocrine ophthalmopathy, was characterized by normal eye pressure (63%) and hypertension (37%). Results. The depth and topography of the area with insufficient blood filling may be considered as a key factor that determines the form of SOAG in endocrine ophthalmopathy. Reduced diastole duration, even under longer systole, was found to aggravate ischemia and lead to disturbed blood distribution in the choroid, involving choroid capillaries directly supplying blood to external layers of retina. Conclusions. The reduction of systolic and diastolic phases of the heart cycle leads to grave deficiency of blood filling with predominate ischemia of the anterior segment of the eye, the ciliary body, edema of the trabecula and disturbed intraocular fluid outflow, resulting in the development of ophthalmic hypertension // Russian Ophthalmological Journal, 2016; 3: 43-9. doi: 10.21516/2072-0076-2016-9-3-43-49.

The influence of the carrier of thyroid autoantibodies (to thyroid-stimulating hormone receptor, to thyroglobulin, to thyroid peroxidase) on the clinical course of endocrine ophthalmopathy (EOP), developed on the background of diffuse toxic goiter (139 patients). We studied the role of carrier of monoantibodies and their combinations. It has been proven a direct link between the presence of the analyzed thyroid autoantibodies and the clinical course of EOP. It is shown that the presence of antibodies to thyroid peroxidase and anti-thyroglobulin antibodies is not a lesser important risk factor for the development of EOP in patients with diffuse toxic goiter than the presence of antibodies to the receptor for thyroid-stimulating hormone, and the multiple carriers is associated with more frequent development of active forms of EOP and higher amplitude of inflammation of the orbit. Thus, serological indices and spectrum of thyroid antibodies revealed the depth of systemic disorders of autoimmunity, associated with an increased risk of the development of local autoimmune inflammation in the orbit and can serve as prognostic risk markers of development of highly active and severe forms of EOP.

The article represents the dynamics of thyrotoxicosis ocular symptoms while carrying out various methods of thyroid disease treatment (drug therapy, operative therapy, radioiodine therapy). During 1 year 139 patients (278 orbital cavities) were observed, with endocrinous ophthalmopathy having been developed in connection with diffuse toxic goiter and different degrees of thyroid disfunction compensation (medicamental euthyroidism, thyrotoxicosis, iatrogenic medicamental hypothyreosis). The monitoring showed the reliable reduction of the detected frequency of 7 out of 11 most frequent thyrotoxicosis ocular symptoms in the background of hormonal state normalization. The authors pay attention to the high frequency of Mobius's symptom revelation at the initial and terminal stages (81.7 and 63.8% accordingly; р

AIMto investigate the contribution of various hemodynamic disturbances in magistral vessels to optic neuropathy (ON) progression and ocular tension changes in endocrine ophthalmopathy (EOP).MATERIAL AND METHODSA total of 39 patients (78 eyes) with subclinical EOP (clinical activity score, CAS ≤ 2) associated with Graves' disease (n = 32, 64 eyes) or autoimmune thyroiditis (n = 7, 14 eyes) were examined. Orbit echography was performed in all patients. Blood flow was assessed with a Voluson 730 PRO ultrasound diagnostic system ("Kretz", Austria) in triplex mode (B-scan, color Doppler flow mapping in combination with pulse-wave Doppler). Thus obtained hemodynamic parameters in ophthalmic artery, central retinal artery (CRA), central retinal vein (CRV), short posterior ciliary arteries (SPCA), and long posterior ciliary arteries (LPCA) were analyzed. To reveal the role of hemodynamic disturbances in the above mentioned vessels in ON progression and eye pressure maintenance, the patients were divided into 7 groups. Only those eyes, whose peripheral indices were increased by more than 25% of normal values and diastolic blood flow decreased by not less than 25%, were selected for further study. Intraocular pressure changes were evaluated by group mean (Mmean = M ± m mmHg), optic neuropathy progression--by the difference in group mean depth (dB) and number of scotomas between the first and the last visit (6 months of observation).RESULTSIn almost all types of perfusion disturbances, the resultant chronic ocular ischemia causes a decrease in IOP. The only exception, as shown, is simultaneous involvement of CRA, SPCA, and LPCA. The level of blood flow disturbance determines the severity of qualitative and quantitative changes in eyes with EOP-associated ON. The rate of ON progression directly correlates with baseline IOP values on day zero.CONCLUSIONLong-lasting chronic impairment of blood supply of the eyeball leads to reduction in ocular tension and progression of optic neuropathy. Combined perfusion disturbances in CRA and LPCA as well as in CRA, LPCA, and SPCA can be considered a high-risk factor, while SPCA and/or LPCA involvement--a moderate-risk factor.

Aim. To perform immune mapping of the peripheral part of visual analyzer and optic nerve in order to identify potential antigenic targets of autoimmune attack. Methods. Eyes enucleated for terminal painful glaucoma (n = 30) were studied. Immunohistochemistry (IHC) was performed on paraffin-embedded sections of isolated retina and optic nerve using a broad panel of antibodies, i.e., monoclonal murine anti-MBP (myelin basic protein) antibodies, polyclonal rabbit anti-alpha fodrin antibodies, monoclonal murine anti-NSE2 (neuron-specific enolase) antibodies, monoclonal murine anti-GFAP (glial fibrillary acidic protein), and polyclonal rabbit anti-S100 antibodies. IHC reaction was visualized using Mouse and Rabbit Specific HRP / AEC Detection IHC Kit. IHC reaction without primary antibodies included was a negative control. IHC reaction was considered as follows: negative — no specific cellular staining or less than 10 % of cells are stained; mild — 10‑30 % of cells are stained (+); moderate — 30‑75 % of cells are stained (++); marked — more than 75 % of cells are stained (+++); overexpression — 100 % of cells intensively express markers. Additionally, staining intensity was considered as mild (+1), moderate (+2), strong (+3) and intense (+4).Results. Immune mapping with a broad panel of monoclonal antibodies identified ocular structures which were stained with IHC markers. Retina was stained with almost all markers of neural differentiation (i.e., antibodies against NSE, GFAP, S100, and α-fodrin) excepting anti-MBP autoantibodies. IHC reaction intensity in retinal layers and structures varied and depended on markers. Moderate (2+) staining with antibodies against MBP, NSE, GFAP, and S100 and marked (3+) staining with antibodies against alpha-fodrin was detected in the cytoplasm of optic nerve glia.Conclusion. Complete labelling of retina structures was performed. As a result, IHC profiles of retinal neurons, optic nerve axons, interneurons, and microglial cells were described. IHC profiles of retinal layers and optic nerve are useful markers which can be applied in serological diagnostics of various ocular disorders.

Aim. To discover and identify thyroid receptors in ocular tissues by means of immunohistochemistry (IHC).Materials and methods.The objects of morphological studies were eyes enucleated for terminal painful glaucoma (n = 30). Thyroid receptors searching was performed in the retina and optic nerve, choroidal and optic nerve vessels. IHC reaction was considered as follows: negative — specific cellular staining is absent or less than 10 % cells are stained; mild positive — 10‑30 % cells are stained (+); moderate positive — 30‑75 % cells are stained (++); highly positive — more than 75 % are stained (+++). Results: Intensive (4+) IHC staining was revealed in the nuclei of inner and outer nuclear and ganglion cell layers. Mild positive (+) staining was detected in the inner segments of photoreceptors. Granular (3+) IHC staining was revealed in the nuclei of optic nerve glia. In choroidea, endotheliocytes nuclei and 20 % stromal cells nuclei were stained. IHCreaction was detected in the cytoplasm of retinal pigment epithelium.Conclusion. The data obtained account for the mechanism of neurohumoral associations at the cellular level. According to these data, eye can be considered as a target for thyroid hormones. The causes of morphological and functional abnormalities of visual analyzer peripheral part in thyroid gland disorders are revealed as well.