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Abstract
Purpose: To study the efficacy, safety, and recurrence rate of intravenous pulse methylprednisolone therapy in patients with acute idiopathic orbital inflammatory syndrome (IOIS). Methods: The clinical records of 30 patients with acute IOIS between 1990 and 2001 were studied retrospectively. All patients had undergone an orbital CT scan and laboratory examinations to confirm the diagnosis of IOIS. Based on the different locations of involved orbital tissues, the patients were divided into five subtypes. Intravenous pulse methylprednisolone therapy was given as the initial treatment, and then shifted to oral prednisolone as tapering or maintenance therapy. The mean follow-up duration was 26.9 ± 22.7 months, with a minimum of 12 months. The efficacy of intravenous pulse methylprednisolone and the recurrence rate of each subtype were investigated. Results: The mean age at first onset was 37.7 ± 13.1 years. Of the 30 patients, 29 (96.7%) responded to the initial pulse methylprednisolone therapy. The mean duration between the beginning of the therapy and the therapeutic response was 3.7 days. A low recurrence rate of 20% (6 in 30 cases) was noted during the follow-up period. The diffuse type of IOIS had a significantly higher recurrence rate (4/9, 44.4%) than the other four subtypes: 1/4 (25.0%) in the posterior type, 1/7 (14.3%) in the anterior type, and none in the lacrimal and myositic types. Three of the six cases (50%) showing recurrence had residual optic atrophy or proptosis; only two of the 24 cured patients (8.3%) had proptosis sequela. None of the patients had major complications or side effects after the intravenous pulse methylprednisolone therapy. Conclusion: Intravenous methylprednisolone pulse therapy is effective and safe as the initial treatment for patients with acute idiopathic orbital inflammation. The diffuse type had a higher recurrence rate than the other four subtypes. The recurrent group had a much higher risk of functional sequela than the cured group.