Publication:
Surgical debulking for idiopathic dacryoadenitis: A diagnosis and a cure

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Issued Date

2014

Resource Type

Article

File Type

application/pdf

ISSN

1616420

DOI

10.1016/j.ophtha.2013.09.010

Other identifier(s)

2-s2.0-84895069037

Rights Holder(s)

มหาวิทยาลัยศรีนครินทรวิโรฒ

Bibliographic Citation

Ophthalmology. Vol 121, No.2 (2014), p.603-609

Suggested Citation

Mombaerts I., Cameron J.D., Chanlalit W., Garrity J.A. Surgical debulking for idiopathic dacryoadenitis: A diagnosis and a cure. Ophthalmology. Vol 121, No.2 (2014), p.603-609. doi:10.1016/j.ophtha.2013.09.010 Retrieved from: https://hdl.handle.net/20.500.14740/7158

Title

Surgical debulking for idiopathic dacryoadenitis: A diagnosis and a cure

Author(s)

Mombaerts I.
 Cameron J.D.
 Chanlalit W.
 Garrity J.A.

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. © 2014 by the American Academy of Ophthalmology Published by Elsevier Inc.

Subject(s)

Corticosteroid
 Dexamethasone
 Immunoglobulin G4
 Methotrexate
 Methylprednisolone
 Rituximab
 Triamcinolone
 Adolescent
 Adult
 Aged
 Article
 Clinical article
 Clinical feature
 Corticosteroid therapy
 Cytoreductive surgery
 Dacryocystitis
 Drug megadose
 Female
 Histopathology
 Human
 Human tissue
 Idiopathic disease
 Immunohistochemistry
 Low drug dose
 Male
 Multicenter study (topic)
 Nuclear magnetic resonance imaging
 Treatment outcome
 Adolescent
 Adult
 Aged
 Child
 Dacryocystitis
 Female
 Follow-Up Studies
 Humans
 Lacrimal Apparatus
 Magnetic Resonance Imaging
 Male
 Middle Aged
 Ophthalmologic Surgical Procedures
 Retrospective Studies
 Tomography, X-Ray Computed
 Treatment Outcome
 Young Adult

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URI

https://hdl.handle.net/20.500.14740/7158

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Scopus: Year 1983-2021

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