Department of Ophthalmology, Universitas Indonesia / Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Department of Anatomical Pathology, Universitas Indonesia / Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Middle East Afr J Ophthalmol. 2024 Jun 14;30(2):89-97. doi: 10.4103/meajo.meajo_225_21. eCollection 2023 Apr-Jun.
The high recurrence rate of idiopathic orbital inflammation (IOI) has been reported. This study aims to determine existing predictive factors for the recurrence of IOI.
This was an 11-year retrospective study with at least a 12-month follow-up. Fifty patients with biopsy-proven IOI admitted between 2006 and 2017 at our tertiary hospital were observed. We compared the clinical characteristics, histopathological profile, and biomarker expressions (mast cell, immunoglobulin G4, tumor necrosis factor-alpha, and transforming growth factor-beta) of 16 patients with recurrence (Group I) and 34 patients with no recurrence (Group II). Statistical comparison and multivariate analysis were performed to establish the predictive factors.
We discovered five recurrence predictive factors: presentation of proptosis (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.36-18.03), visual impairment (OR 15, 95% CI 1.58-142.72), extraocular muscle (EOM) restriction (OR 3.86, 95% CI 1.07-13.94), nonanterior involvement (OR 7.94, 95% CI 1.88-33.5), and corticosteroid (CS) alone treatment (OR 7.20, 95% CI 1.87-27.8). On multivariate analysis, nonanterior involvement and CS alone treatment were validated as predictive factors (area under the curve = 0.807 [95% CI 0.69-0.92]). Histopathological profile and biomarker expressions were not associated with recurrence. However, there was a 22-fold higher recurrence risk for granulomatous-type patients given CS alone treatment.
Unlike the five clinical characteristics mentioned, both histopathology and biomarker variables were not associated with recurrence. CS alone treatment for patients with nonanterior involvement or granulomatous type is proven to increase the risk of recurrence. Therefore, we suggest not giving CS without any combination treatment with other modalities for this group of patients.
特发性眼眶炎症（IOI）的复发率较高。本研究旨在确定 IOI 复发的现有预测因素。
这是一项回顾性研究，时间为 11 年，随访时间至少为 12 个月。在我们的三级医院，观察了 2006 年至 2017 年间经活检证实的 50 例 IOI 患者。我们比较了 16 例复发患者（I 组）和 34 例无复发患者（II 组）的临床特征、组织病理学特征和生物标志物表达（肥大细胞、免疫球蛋白 G4、肿瘤坏死因子-α和转化生长因子-β）。进行了统计学比较和多变量分析，以确定预测因素。
我们发现了五个复发预测因素：眼球突出（优势比 [OR] 4.96，95%置信区间 [CI] 1.36-18.03）、视力损害（OR 15，95%CI 1.58-142.72）、眼外肌（EOM）受限（OR 3.86，95%CI 1.07-13.94）、非前侧受累（OR 7.94，95%CI 1.88-33.5）和单独使用皮质类固醇（CS）治疗（OR 7.20，95%CI 1.87-27.8）。多变量分析证实，非前侧受累和 CS 单独治疗是预测因素（曲线下面积=0.807 [95%CI 0.69-0.92]）。组织病理学特征和生物标志物表达与复发无关。然而，单独给予 CS 治疗的肉芽肿型患者复发风险增加 22 倍。
与上述五个临床特征不同，组织病理学和生物标志物变量均与复发无关。对于非前侧受累或肉芽肿型患者，单独给予 CS 治疗会增加复发风险。因此，我们建议对于这组患者，在不与其他治疗方式联合使用的情况下，不要单独使用 CS。
