Abstract | PURPOSE: Idiopathic inflammatory tumor of the lacrimal gland, also called idiopathic dacryoadenitis, generally is treated with high-dose, long-term systemic corticosteroids, despite their limited success, high recurrence rate, and incidence of drug-induced side effects. This study describes the outcome of patients with idiopathic dacryoadenitis who were managed with surgical debulking. DESIGN: Retrospective case series from 2 tertiary referral centers. PARTICIPANTS: Forty-six patients (46 lacrimal glands). METHODS: Review of the clinical records, radiologic scans, and histopathologic specimens, with additional immunoglobulin G4 immunostaining. MAIN OUTCOME MEASURES: Clinical signs and symptoms at 2 months after the surgery and off medications. RESULTS: Before referral, 41% (19 of 46) of the patients had received systemic high-dose corticosteroids, after which they all showed recurrence, of whom 26% (5 of 19) became dependent on corticosteroids. At referral, all patients underwent debulking surgery of the inflammatory lacrimal gland mass for diagnostic and therapeutic reasons. Additionally, intralesional or systemic low-dose corticosteroids were given during the operation or the first postoperative days in 54% (25 of 46) of the patients. At 2 months after the debulking surgery, a full clinical recovery was seen in 80% (37 of 46) of the patients. A recurrence occurred in 8% (3 of 37) of the patients 4 months and 2.2 and 4.6 years later. Surgical failure (20%; 9 of 46) was correlated with prior corticosteroid treatment (P = 0.002, Fisher exact test), but not with sclerosing inflammation present in 28% (13 of 46). The median follow-up time was 7.2 years (range, 0.7-18 years). CONCLUSIONS: Debulking biopsy procedures for idiopathic dacryoadenitis, in addition to being diagnostic, may be therapeutic.
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Authors | Ilse Mombaerts, J Douglas Cameron, Waruttaporn Chanlalit, James A Garrity |
Journal | Ophthalmology
(Ophthalmology)
Vol. 121
Issue 2
Pg. 603-9
(Feb 2014)
ISSN: 1549-4713 [Electronic] United States |
PMID | 24572677
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. |
Topics |
- Adolescent
- Adult
- Aged
- Child
- Dacryocystitis
(diagnosis, surgery)
- Female
- Follow-Up Studies
- Humans
- Lacrimal Apparatus
(surgery)
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Ophthalmologic Surgical Procedures
- Retrospective Studies
- Tomography, X-Ray Computed
- Treatment Outcome
- Young Adult
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