September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Biopsy proven idiopathic orbital inflammatory disease - clinical features, management and treatment outcomes
Author Affiliations & Notes
  • Eric Spink
    Ophthalmology, Newcastle upon tyne NHS trust, Newcastle upon Tyne, United Kingdom
  • Darren Ting
    Ophthalmology, Newcastle upon tyne NHS trust, Newcastle upon Tyne, United Kingdom
  • Lucy Clarke
    Ophthalmology, Newcastle upon tyne NHS trust, Newcastle upon Tyne, United Kingdom
  • Footnotes
    Commercial Relationships   Eric Spink, None; Darren Ting, None; Lucy Clarke, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 712. doi:
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      Eric Spink, Darren Ting, Lucy Clarke; Biopsy proven idiopathic orbital inflammatory disease - clinical features, management and treatment outcomes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):712.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We evaluated the clinical features, management and clinical outcome of biopsy proven idiopathic orbital inflammatory disease (IOID), from a UK tertiary referral centre. Our aim was to identify prognostic factors that may be used to guide management.

Methods : This was a retrospective, clinical–pathological, interventional, case series of biopsy proven IOID between 2006 and 2014 from the Newcastle Eye Centre (Newcastle upon Tyne, UK). Data was collected from the patient notes, clinic letters and the local patient database.

Results : 17 cases were identified for analysis: 8 patients (48%) were male, with a mean age of 51.9 ± 11.1 years. Of these cases the largest group showed non-specific inflammation; 15 (88%) of which 3 (18%) displayed IgG4 expression. There was also 1 case of granulomatous sarcoidosis and 1 case of granulomatosis with polyangiitis.
3 cases(18%) were managed without systemic corticosteroids or other immunosuppressant medication. 11 cases (65%) were managed with steroids alone; with an average cumulative dose of 2.8g over a mean course of 23.5 weeks. 3 patients (18%) required other immunosuppressive treatment at different stages of their management. Of the cases managed with steroids alone 6 had a single course of treatment however 5 (45%) relapsed with 4 cases requiring a further course of systemic steroids and 1 case methotrexate. Of the 3 cases which displayed IgG4 expression 2 (67%) relapsed after steroids were discontinued requiring a further course. 2 patients (12%) are currently on long term systemic steroid treatment to prevent relapse. Pain (71%) and proptosis (71%) were the most common clinical features observed. 5 (29%) patients had a complete resolution of all of their symptoms following treatment and all of the remaining patients had a partial improvement.

Conclusions : The established management of orbital inflammatory disease is with systemic steroids, this series highlights the need for a significant course of tapering treatment. A large proportion of cases treated with steroids relapse and require further courses of treatment. These factors should be considered when counselling patients with OID and deciding upon gastric and bone protection. In this case series patients with IgG4 have a higher incidence of recurrence.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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