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C. N. Singh, A. J. Amadi, B. S. Sires, R. Mudumbai; Retroseptal Steroids for Orbital Pseudotumor. Invest. Ophthalmol. Vis. Sci. 2007;48(13):946.
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To report 4 cases of histologically confirmed orbital pseudotumor treated with retroseptal triamcinolone.
Retrospective case series.
Case 2 had elevated serum ACE, and Case 3 had positive C-ANCA. Otherwise, workup for sarcoidosis, Wegener's granulomatosis, neoplastic, and infectious causes was negative. Cases 3 and 4 developed ocular hypertension requiring topical treatment. Case 4 developed a cataract requiring surgery.Case 1: A 53 year old male presented with 2 days of blurry vision and diplopia OD. MRI showed lateral and inferior rectus enlargement at the apex. Symptoms improved on prednisone, then recurred at 1 year. MRI showed an enhancing lesion involving the lateral and inferior recti with mass effect on CN 2. Biopsy showed granulomatous inflammation. A 40 mg retrobulbar injection of triamcinolone was given. His symptoms resolved over 10 days. He has been stable over 18 months.Case 2: A 43 year old male presented with 2 years of paresthesias and a supranasal orbital mass OD. CT showed an intra and extraconal mass. Biopsy showed granulomatous inflammation. A 20 mg retrobulbar injection of triamcinolone was given. The mass shrunk and paresthesias resolved at 1 week. He has been stable over 6 months.Case 3: A 52 year old male presented with 4 weeks of pain and hypertropia OD. CT showed a medial orbital mass with thickened inferior and medial recti. His symptoms resolved on prednisone but recurred at 1 week. Biopsy showed nongranulomatous inflammation. A 20 mg retrobulbar injection of triamcinolone was given, with improvement in symptoms at 1 month. He has been stable over 1 year on cyclophosphamaide and mycophenolate mofetil.Case 4: A 35 year old female presented with a headache and relapsing/remitting CN III and CN VI palsies OD. MRI revealed pituitary enlargement. Pituitary biopsy showed noncaseating granulomatous inflammation. Her symptoms resolved on prednisone, but recurred at 1 month, and resolved after methotrexate was added. She presented again 6 months later with diplopia, a paracentral scotoma and disc edema OS. MRI showed an enhancing lesion in the left orbit surrounding CN II. A 20 mg retrobulbar injection of triamcinolone was given. Her symptoms resolved, but recurred 5 months later. A repeat triamcinolone injection was given, followed by resolution of her diplopia. Infliximab was added. She has been stable over 3 years.
Retroseptal triamcinolone can be considered as an alternative or adjunct treatment in patients with orbital pseudotumor who can't tolerate systemic treatment or have recurrent disease. Complications include cataract and ocular hypertension.
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