Mombaerts Ilse, Bilyk Jurij R, Rose Geoffrey E, McNab Alan A, Fay Aaron, Dolman Peter J, Allen Richard C, Devoto Martin H, Harris Gerald J
Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
Wills Eye Hospital, Philadelphia, Pennsylvania.
JAMA Ophthalmol. 2017 Jul 1;135(7):769-776. doi: 10.1001/jamaophthalmol.2017.1581.
Current practice to diagnose idiopathic orbital inflammation (IOI) is inconsistent, leading to frequent misdiagnosis of other orbital entities, including cancer. By specifying criteria, diagnosis of orbital inflammation will be improved.
To define a set of criteria specific for the diagnosis of IOI.
DESIGN, SETTING, AND PARTICIPANTS: A 3-round modified Delphi process with an expert panel was conducted from June 8, 2015, to January 25, 2016. Fifty-three orbital scientist experts, identified through membership in the Orbital Society, were invited to participate in on online survey and they scored, using 5-point Likert scales, items that are eligible as diagnostic criteria from the literature and from personal experience. The items were clustered around the anatomic subtypes of IOI: idiopathic dacryoadenitis and idiopathic orbital fat inflammation (2 nonmyositic IOIs), and idiopathic orbital myositis (myositic IOI). Items with dissensus were rescored in the second round, and all items with consensus (median, ≥4; interquartile range, ≤1) were ranked by importance in the third round.
Consensus on items to be included in the criteria.
Of the 53 experts invited to participate, a multinational panel of 35 (66%) individuals with a mean (SD) years of experience of 31 (11) years were included. Consensus was achieved on 7 of 14 clinical and radiologic items and 5 of 7 pathologic items related to diagnosis of nonmyositic IOI, and 11 of 14 clinical and radiologic items and 1 of 5 pathologic items for myositic IOI. There was agreement among panelists to focus on surgical tissue biopsy results in the diagnosis of nonmyositic IOI and on a trial with systemic corticosteroids in myositic IOI. Panelists agreed that a maximum number of 30 IgG4-positive plasma cells per high-power field in the orbital tissue is compatible with the diagnosis of IOI.
An international panel of experts endorsed consensus diagnostic criteria of IOI. These criteria define a level of exclusion suggested for diagnosis and include tissue biopsy for lesions not confined to the extraocular muscles. This consensus is a step toward developing guidelines for the management of IOI, which needs to be followed by validation studies of the criteria.
目前诊断特发性眼眶炎症（IOI）的方法并不一致，常导致对包括癌症在内的其他眼眶疾病的误诊。通过明确诊断标准，眼眶炎症的诊断将得到改善。
确定一套特发性眼眶炎症的诊断标准。
设计、背景和参与者：2015年6月8日至2016年1月25日，与专家小组进行了三轮改良德尔菲法。通过眼眶学会成员身份确定的53位眼眶科学家专家受邀参加在线调查，他们使用5级李克特量表对从文献和个人经验中筛选出的符合诊断标准的项目进行评分。这些项目围绕IOI的解剖学亚型进行分类：特发性泪腺炎和特发性眼眶脂肪炎（2种非肌炎型IOI）以及特发性眼眶肌炎（肌炎型IOI）。第二轮对存在分歧的项目重新评分，第三轮对所有达成共识的项目（中位数≥4；四分位间距≤1）按重要性进行排序。
就纳入标准的项目达成共识。
受邀参与的53位专家中，有35位（66%）组成了一个跨国小组，其平均（标准差）工作年限为31（11）年。在与非肌炎型IOI诊断相关的14项临床和放射学项目中的7项以及7项病理学项目中的5项上达成了共识，在肌炎型IOI的14项临床和放射学项目中的11项以及5项病理学项目中的1项上达成了共识。专家小组成员一致认为，在非肌炎型IOI的诊断中应重点关注手术组织活检结果，在肌炎型IOI中应进行全身糖皮质激素试验。专家小组成员一致认为，眼眶组织中每高倍视野IgG4阳性浆细胞最多30个符合IOI的诊断。
一个国际专家小组认可了IOI的共识诊断标准。这些标准定义了诊断所需的排除水平，并包括对不限于眼外肌的病变进行组织活检。这一共识是制定IOI管理指南的第一步，随后需要对这些标准进行验证研究。
