Clinical Features and Results of Steroid Therapy for Orbital Inflammatory Pseudotumor

Mi Sun Sung; Han Jin Oh; Byung Yi Ko; Kyung Chul Yoon

doi:10.3341/jkos.2013.54.2.185

Journal List > J Korean Ophthalmol Soc > v.54(2) > 1009558

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Sung, Oh, Ko, and Yoon: Clinical Features and Results of Steroid Therapy for Orbital Inflammatory Pseudotumor

Original Article

J Korean Ophthalmol Soc 2012;54(2):185-191.

Published online: 2 January 2012

DOI: https://doi.org/10.3341/jkos.2013.54.2.185

Clinical Features and Results of Steroid Therapy for Orbital Inflammatory Pseudotumor

Mi Sun Sung, MD¹, Han Jin Oh, MD¹, Byung Yi Ko, MD, PhD², Kyung Chul Yoon, MD, PhD¹

¹Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

²Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6741, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 17 March 20126 May 2012 Accepted 2 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical features and treatment outcomes of steroid therapy for orbital inflammatory pseudotumor.

Methods

Sixty-four patients diagnosed with orbital inflammatory pseudotumor were reviewed retrospectively. Patients with a follow-up period of less than 6 months were excluded from the study. The pseudotumor was classified into myositic, lacrimal, anterior, diffuse, or apical type according to orbital computed tomography findings. All patients were initially treated with systemic corticosteroids and evaluated for response to the treatment. Treatment outcome was considered a “success” if the patient had complete relief of symptoms with no recurrence, and a “failure” if the patient had no or only partial relief of symptoms or showed relapse. Factors affecting the treatment outcome were analyzed.

Results

The most frequent lesion subtype was myositis. Periorbital edema was the most common symptom and was evident in 53.1% of the patients. Thirty-eight patients (59.4%) showed treatment success. Age, sex, bilaterality, and mean follow-up length did not correlate with the treatment outcome. A short interval from symptom onset to treatment time and apical subtype were significantly associated with good steroid response (p < 0.05).

Conclusions

In orbital inflammatory pseudotumor, myositis was the most common subtype. A short interval from symptom onset to treatment time and apical subtype were associated with good steroid response.

Keywords: Myositis, Orbital inflammatory pseudotumor, Periorbital edema

References

1. Birch-Hirschfeld A. Zur diagnostic and pathologic der orbital tumoren. Ber Zusammenkunft Dtsch Ophthamol Ges. 1905; 32:127–35.

2. Ding ZX, Lip G, Chong V. Idiopathic orbital pseudotumor. Clin Radiol. 2011; 66:886–92.

3. Rubin PA, Foster CS. Etiology and management of idiopathic orbital inflammation. Am J Ophthalmol. 2004; 138:1041–3.

4. Weber AL, Jakobiec FA, Sabates NR. Pseudotumor of the orbit. Neuroimaging Clin N Am. 1996; 6:73–92.

5. Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, Part 1. Ophthalmology. 2004; 111:997–1008.

6. Mombaerts I, Goldschmeding R, Schlingemann RO, Koornneef L. What is orbital pseudotumor? Surv Ophthalmol. 1996; 41:66–78.

7. Rootman J, McCarthy M, White V, et al. Idiopathic sclerosing inflammation of the orbit. A distinct clinicopathologic entity. Ophthalmology. 1994; 101:570–84.

8. Jacobs D, Galetta S. Diagnosis and management of orbital pseudotumor. Curr Opin Ophthalmol. 2002; 13:347–51.

9. Yuen SJ, Rubin PA. Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol. 2003; 121:491–9.

10. Hatton MP, Rubin PA, Foster CS. Successful treatment of idiopathic orbital inflammation with mycophenolate mofetil. Am J Ophthalmol. 2005; 140:916–8.

11. Garrity JA, Coleman AW, Matteson EL, et al. Treatment of recalcitrant idiopathic orbital inflammation (chronic orbital myositis) with infliximab. Am J Ophthalmol. 2004; 138:925–30.

12. Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L. Are systemic corticosteroids useful in the management of orbital pseudotumors? Ophthalmology. 1996; 103:521–8.

13. Swamy BN, McCluskey P, Nemet A, et al. Idiopathic orbital inflammatory syndrome: clinical features and treatment outcomes. Br J Ophthalmol. 2007; 91:1667–70.

14. Chirapapaisan N, Chuenkongkaew W, Pornpanich K, Vangveeravong S. Orbital pseudotumor: clinical features and outcomes. Asian Pac J Allergy Immunol. 2007; 25:215–8.

15. Park SJ, Sin SJ, Lee DG, Jang JW. Pseudotumor: distribution, clinical features, treatment outcomes. J Korean Ophthalmol Soc. 2008; 49:1379–86.

16. Lee H, Kim SJ, Lee SY. Classification and treatment efficacy of orbital pseudotumor. J Korean Ophthalmol Soc. 2001; 42:1647–54.

17. Cho KR, Kim JH. Diagnosis of idiopathic inflammatory pseudotumor of the orbit. J Korean Ophthalmol Soc. 1991; 32:134–42.

18. Rootman J, Nugent R. The classification and management of acute orbital pseudotumors. Ophthalmology. 1982; 89:1040–8.

19. Scott IU, Siatkowski RM. Idiopathic orbital myositis. Curr Opin Rheumatol. 1997; 9:504–12.

20. Gordon LK. Orbital inflammatory disease: a diagnostic and therapeutic challenge. Eye (Lond). 2006; 20:1196–206.

21. Sitakowski RM, Capó H, Byrne SF, et al. Clinical and echographic findings in idiopathic orbital myositis. Am J Ophthalmol. 1994; 118:343–50.

22. McNicholas MM, Power WJ, Griffin JF. Idiopathic inflammatory pseudotumour of the orbit: CT features correlated with clinical outcome. Clin Radiol. 1991; 44:3–7.

23. Henderson JW, Farrow GM. Orbital tumors. New York: Brian C. Decker;1980. p. 512.

24. Brannan PA. A review of sclerosing idiopathic orbital inflammation. Curr Opin Ophthalmol. 2007; 18:402–4.

Figure 1.

Frequency of signs and symptoms of orbital inflammatory pseudotumor.

Figure 2.

Characteristics of orbital myositis. (A) Site of involvement. (B) Number of muscle involved. M RM = medial rectus muscle; SRM = superior rectus muscle; LRM = lateral rectus muscle; IRM = inferior rectus muscle.

Table 1.

Demographics of 64 patients with orbital inflammatory pseudotumor

		Discription
Age (years)	Mean ± SD	49.50 ± 17.74
	Range	9-84
Sex	Male	34 (53.1%)
	Female	30 (46.9%)
Laterality	Unilateral	57 (89.1%)
	Bilateral	7 (10.9%)
Classification	Myositis	22 (34.4%)
	Lacrimal gland	17 (26.6%)
	Anterior	10 (11.8%)
	Diffuse	6 (7.1%)
	Apical	9 (10.6%)
Interval between symptom onset and	Mean ± SD	27.21 ± 49.95
treatment (days)	Range	2-365
Follow up duration (months)	Mean ± SD	14.48 ± 13.33
	Range	6-52

SD = standard deviation.

Table 2.

Mean age, interval between symptom onset and treatment and follow up duration of different subtypes

	Age (years)	Interval between symptom onset and treatment (days)	Follow up duration (months)
Myositis	44.41 ± 17.55	25.50 ± 40.14	14.68 ± 13.74
Lacrimal gland	48.24 ± 14.24	45.41 ± 83.36	17.71 ± 17.32
Anterior	53.50 ± 20.82	18.70 ± 12.95	13.70 ± 11.59
Diffuse	49.67 ± 22.98	13.83 ± 8.59	8.67 ± 6.53
Apical	59.78 ± 15.30	15.44 ± 13.95	12.67 ± 8.59
p-value^*	0.230	0.230	0.632

Data are expressed as mean ± standard deviation (SD).

^* Kruskal-wallis test.

Table 3.

Univariate analysis for factors affecting outcome of systemic steroid treatment in patients with orbital inflammatory pseudotumor

Variables	Number of patients (%)		p-value
Variables	Treatment success group	Treatment failure group	p-value
Age, Mean ± SD (years)	48.84 ± 19.11	50.46 ± 15.84	0.713^*
			0.924^†
Sex
Male	20 (58.8)	14 (41.2)
Female	18 (60)	12 (40)
			0.035^†
Laterality
Unilateral	31 (54.4)	26 (45.6)
Bilateral	7 (100)	0 (0)
			0.036^†
Classification
Myositis	11 (50)	11 (50)
Lacrimal gland	10 (58.8)	7 (41.2)
Anterior	8 (80)	2 (20)
Diffuse	1 (16.7)	5 (83.3)
Apical	8 (88.9)	1 (11.1)
Interval between symptom onset and treatment
Mean ± SD (days)	16.68 ± 11.76	42.62 ± 75.29	0.045^*
Follow up duration
Mean ± SD (months)	15.68 ± 13.67	12.73±12.87	0.393^*

SD = standard deviation.

^* Student t-test;

^† Chi-square test.

Table 4.

Multivariate analysis for factors affecting outcome of systemic steroid treatment in patients with orbital inflammatory pseudotumor

Variable	Odds ratio	95% CI	p-value^*
Laterality
Unilateral	1.000
Bilateral	0.035	0.001-1.026	0.055
Classification			0.124
Myositis	1.000
Lacrimal gland	0.565	0.121-2.634	0.467
Anterior	0.348	0.049-2.470	0.291
Diffuse	4.325	0.400-46.754	0.228
Apical	0.087	0.008-0.992	0.049
Interval between symptom onset and treatment	1.054	1.004-1.105	0.033

CI = confidence interval.

^* Multivariate logistic regression analysis.

TOOLS

Similar articles