Cytokines are both villains and potential therapeutic targets in thyroid-associated ophthalmopathy: From bench to bedside.

The pathophysiology underlying Graves' disease and its ocular manifestation, thyroid associated ophthalmopathy (TAO) is incompletely understood. Characterization of the mononuclear cells driving the disease and the cytokines they produce has led to significant advances in our understanding of TAO. This in turn has resulted in the identification of potentially attractive drug targets.

Rituximab (Rituxan) therapy for severe thyroid-associated ophthalmopathy diminishes IGF-1R(+) T cells.

Context: Rituximab depletes CD20(+) B cells and has shown potential benefit in thyroid-associated ophthalmopathy (TAO). The impact of rituximab on T cell phenotype in TAO is unexplored.

Objective: The objective of the study was to quantify the abundance of IGF-I receptor-positive (IGF-1R(+)) CD4 and CD8 T cells in active TAO before and after treatment with rituximab.

Development and validation of an improved neurological hemifield test to identify chiasmal and postchiasmal lesions by automated perimetry.

Purpose: To improve the neurological hemifield test (NHT) using visual field data from both eyes to detect and classify visual field loss caused by chiasmal or postchiasmal lesions.

Methods: Visual field and clinical data for 633 patients were divided into a training set (474 cases) and a validation set (159 cases). Each set had equal numbers of neurological, glaucoma, or glaucoma suspect cases, matched for age and for mean deviation between neurological and glaucoma cases.

Blindness, weakness, and tingling.

A previously healthy 50-year-old man complained of acute bilateral loss of vision over 24 hours associated with tingling of his hands and feet. During the first 48 hours of hospitalization, he evolved quadriplegia, facial diplegia, bulbar palsy, and respiratory distress requiring ventilator assistance. At the same time vision deteriorated to hand motions.

Emerging treatments for choroidal metastases.

It has been over a century since Perls described the first case of choroidal metastasis. For the next six decades only 230 cases were described in the literature. Today, however, ocular metastasis is recognized as the most common intraocular malignancy.

Evaluation of an algorithm for detecting visual field defects due to chiasmal and postchiasmal lesions: the neurological hemifield test.

Purpose: To develop an automated neurologic hemifield test (NHT) to detect visual field loss caused by chiasmal or postchiasmal lesions.

Methods: Visual field locations from 24-2 pattern automated visual fields were grouped into two symmetric regions with 16 points on either side of the vertical meridian. A scoring system similar to the Glaucoma Hemifield Test (GHT) was used to calculate point scores using the pattern deviation values from the right and left regions.

Reversible vision loss secondary to malnutrition in a woman with severe anorexia nervosa, purging type, and alcohol abuse.

Objective: To report a case of severe reversible vision loss in a woman with a 7-year history of anorexia nervosa, purging type, alcohol abuse and a severely restricted, vitamin-deficient diet.

Method: Psychiatric, ophthalmologic, and medical records were reviewed, and a literature search was performed on visual complications associated with anorexia nervosa and malnutrition.

Discussion: Ophthalmologic complications of malnutrition are rare but include both oculomotor and visual sensory disturbances.

Surgical management of hypotony owing to overfiltration in eyes receiving glaucoma drainage devices.

Purpose: To assess rates of surgical revision of glaucoma drainage devices (GDDs) from hypotony owing to overfiltration and its management.

Design: Retrospective case series.

Methods: Demographic characteristics, type of GDD implanted, type of surgical revision, and outcomes were obtained from the charts of patients undergoing GDD implantation and > or = 1 subsequent GDD revision in 2002 to 2006.

Posterior cingulate cortex mediates outcome-contingent allocation of behavior.

Adaptive decision making requires selecting an action and then monitoring its consequences to improve future decisions. The neuronal mechanisms supporting action evaluation and subsequent behavioral modification, however, remain poorly understood. To investigate the contribution of posterior cingulate cortex (CGp) to these processes, we recorded activity of single neurons in monkeys performing a gambling task in which the reward outcome of each choice strongly influenced subsequent choices.

Risk-sensitive neurons in macaque posterior cingulate cortex.

People and animals often demonstrate strong attraction or aversion to options with uncertain or risky rewards, yet the neural substrate of subjective risk preferences has rarely been investigated. Here we show that monkeys systematically preferred the risky target in a visual gambling task in which they chose between two targets offering the same mean reward but differing in reward uncertainty. Neuronal activity in posterior cingulate cortex (CGp), a brain area linked to visual orienting and reward processing, increased when monkeys made risky choices and scaled with the degree of risk.

Expectations and outcomes: decision-making in the primate brain.

Success in a constantly changing environment requires that decision-making strategies be updated as reward contingencies change. How this is accomplished by the nervous system has, until recently, remained a profound mystery. New studies coupling economic theory with neurophysiological techniques have revealed the explicit representation of behavioral value.

Saccade reward signals in posterior cingulate cortex.

Movement selection depends on the outcome of prior behavior. Posterior cingulate cortex (CGp) is strongly connected with both limbic and oculomotor circuitry, and CGp neurons respond following saccades, suggesting a role in signaling the motivational outcome of gaze shifts. To test this hypothesis, single CGp neurons were studied in monkeys while they shifted gaze to visual targets for liquid rewards that varied in size or were delivered probabilistically.