Intraorbital corticosteroid injection for the treatment of IgG4-related ophthalmic disease. Issue 5 (21st August 2015)

• Record Type: Journal Article
• Authors: Andrew, Nicholas H; Gajdatsy, Adam; Selva, Dinesh
• Is Part Of: British journal of ophthalmology. Volume 100:Issue 5(2016)
• Page Start: 644
• Page End: 647
• Publication Date: 2015-08-21
• Subjects: Orbit -- Inflammation -- Treatment Medical; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2015-307164
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aim: To review the efficacy of intraorbital corticosteroid injection for the treatment of IgG4-related ophthalmic disease (IgG4-ROD). Methods: This study was a retrospective twin-centre histopathology review and observational case series. A chart review was undertaken for 10 cases of biopsy-confirmed IgG4-ROD treated with intraorbital corticosteroid injection. The main outcome measures were the magnitude, onset and duration of the clinical response. Results: All cases received intraorbital injection(s) of 20 or 40 mg doses of triamcinolone acetonide suspension (Kenacort-A 40, Bristol-Myers Squibb, Australia). Intraorbital corticosteroid injection was associated with a swift positive response in all cases. 50% of cases achieved complete and sustained clinical remission during mean follow-up of 41 months. This was achieved with a single injection in three cases and with repeat injections in two cases. Peak clinical improvement was reached in ≤7 days following 61% of injections. 60% of cases suffered relapse and 56% of relapses occurred during weeks 3 or 4 following injection. Sclerosing histology was associated with a clinical response that was gradual in onset (p=0.01) and that tended to be incomplete (p=0.4). There were no complications of injection other than brief discomfort. Conclusions: Intraorbital injection of corticosteroid may be a useful treatment option for IgG4-ROD. It may have a role as a first-line therapy in selected cases of IgG4-ROD centred in the anterior orbit. However, most cases require repeat injections due to incomplete response and relapse.