Clinical Analysis Of Idiopathic Orbital Inflammatory Pseudotumor

Idiopathic orbital inflammatory pseudotumor(IOIP),is oneof the most common diseases in the orbit.This disease wasreported by Birch – Hirchfield first in 1905.Its clinical andimaging picture changes from patient to patient.ClinicallyIOIP can be divided into acute,subacute,and chronic form,showing both inflammatory and tumor-like features . Itsdiagnosis and therapy is very difficult.25 cases(26eyes)of IOIP were reviewed with specialattention to the therapeutic evaluation,to summarize clinicaland imaging features and the comparison of surgicalmanagement with corticosteroids therapy,thus to improve thediagnostic threshold of this disease.Altogether 18 cases weremales,and 7 cases females.It occurs in individuals 10~68years of age(mean age, 47.9 years).There were child patient1 case,young patient 9 cases(10eyes),middle-aged patient10cases,older patient 5 case. the course of disease rangedform 20day to-3years.Data showed that 3 of 25 IOIP casessuffered from sinusitis,1 cases suffered from rhinallergosis,1 case suffered from diabetes and exposure keratitis,and 1case suffered from rheumatoid arthriti,pulmonary tuberculosisand genyantritis.Clinical diagnosis of the 9 patients depends on the presentclinical signs and imaging checks while to exclude otherfactors,of 16 patients which preoperative disgnosis wereintraorbital tumors by histopathology. There were 9 patientsunderwent systemtic corticosteroids treatment and 16 patientsunderwent acombined surgical management and corticosteroidThe present clinical signs : Protosis(64%), palpablemass(56%),and ocular motility restriction(40%) were the mostcommon presenting signs.The basic pathology of IOIP wasthat there was a polymorphous infiltrate composed of maturelymphocytes, plasma cells, eosinophis, macrophages,andpolymorphonuclear leukocytes,with are active dense fibrosisand capillary proliferation in the orbital soft tissues.Thedistribution of histopathological subtypes:of the 16 patientwhich were available on pathological reexamination,9 caseswere diffuse infuse infilteative subtype,1 fibrotic subtype,6mixed subtype,B-ultrasonography showed a tumor with lowreflection and strong sound transmission indiffuse lymphocyticinfiltrative pseudotumor.A tumor with fibroproliferative lesionhad low reflectionweak sound transmission and irregularborder.According to CT findings,intraorbital inflammatorypseudotumors can be divided into four types , includingacrimalglanditis,myositis,inflammatory mass,diffuse type. Thecomparison of the therapy effect of various treatments.Allpatient underwent either systemtic corticosteroids treatment oracombined surgical management and corticosteroids with afollow-up time of an average1.5 years.The results of therapyshowed that the cure rates of combined surgical managementand corticosteroids were 56.3%, The cure rates of cortic-osteroids systemtic were 33.3%.The total success rate was48%.The recurrent rate of corticosteroids systemtic were22.2%, of combined surgical management and corticosteroidswere 6.25%.The total recurrent was 12%.According to these case, we can conclude:Proptosis,palpable mass,swollen eyelid, and motility restriction were themost common presenting signs of IOIP.Using various imagingexaminations are valuable for the diagnosis , differentialdiagnosis,the evaluation of histopathology types.Surgicalexcision with corticosteroid is an effective treatment option ofIOIP,but orbital myositis responds well to corticosteroids.