Review of clinical features, practice patterns, and treatment outcomes of idiopathic dacryoadenitis at major oculoplastic referral clinics in Toronto, Canada
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Quoi:
Paper Presentation | Présentation d'article
Partie de:
Quand:
1:48 PM, Vendredi 1 Juin 2018
(6 minutes)
Où:
Metro Toronto Convention Centre (Édifice Sud)
- Salle 714 A
Authors: Harleen Bedi, Harmeet Gill, Navdeep Nijhawan, Dan DeAngelis, James Oestreicher, Nancy Tucker
Author Disclosure Block: H. Bedi: None. H. Gill: None. N. Nijhawan: None. D. DeAngelis: None. J. Oestreicher: None. N. Tucker: None.
Abstract Body:
Purpose: Current management of idiopathic dacryoadenitis is perplexed by marked variability in clinical approaches that are practioner-dependent, and range from initial conservative medial management with corticosteroids to an aggressive primary debulking of the affected lacrimal gland. The primary aims of this study were to determine the rate of treatment response, treatment recalcitrance and disease recurrence, and to formulate an approach toward management of idiopathic dacryoadenitis. Secondary aims of this study were to review the histopathologic features of lacrimal gland biopsies to assess the distribution of pathology.
Study Design: This prospective, multi-centre observational clinical chart review identified all patients with the diagnosis of idiopathic dacryoadenitis from various Oculoplastic practices in Toronto, Canada.
Methods: Each patient’s initial presentation, management and treatment outcomes were collected. The rate of treatment response, recalcitrance and disease recurrence was measured and histopathologic features of lacrimal gland biopsies were evaluated for distribution of pathology. Patients were followed over 6 months post completion of therapy to measure recurrent attacks, dry eye symptoms, and/or use of anti-inflammatory medications. Data was analyzed using Fisher exact test (2-tailer) and Student t-test (2-tailed) with statistical significance defined at p<0.05.
Results: Forty-two cases of idiopathic dacryoadenitis have been included. Our study population showed a female preponderance (81% women, 19% men) and a mean age of 50 (+SD 11.9) years. Bilateral lacrimal gland involvement was seen in 40% cases. An even distribution of “classic” dacryoadenitis with moderate inflammation (52.3%) and painless orbital mass effect (47.7%) was seen clinically. Concomitant autoimmune or allergic disease was observed in 52.3% patients. Radiologically, 42.9% patients presented with isolated enlargement of the lacrimal gland. Of those who showed concurrent orbital involvement, inflammation was commonly seen extending to extraocular muscles (66.7%), orbital fat (77.8%) and optic nerve (11.1%). A total of 90% of patients were initiated on prednisone therapy, approximately half (47%) of who relapsed. Most patients required a mean treatment period of 4.8 months (95% CI 3 to 6.6 months). Of these patients, complete resolution seen in 50%, 33.3% became recalcitrant and 16.7% showed incomplete response.
Conclusions: Half of the patients with idiopathic dacryoadenitis showed a complete resolution on oral prednisone therapy. Clinical remission was achieved in 83.3% of the population on oral therapy alone, thereby necessitating debulking surgical or radiation therapy for a minority of patients diagnosed with this entity. Our findings provide an approach to management of idiopathic dacryoadenitis, which will help inform practice decisions in the primary care setting.
Author Disclosure Block: H. Bedi: None. H. Gill: None. N. Nijhawan: None. D. DeAngelis: None. J. Oestreicher: None. N. Tucker: None.
Abstract Body:
Purpose: Current management of idiopathic dacryoadenitis is perplexed by marked variability in clinical approaches that are practioner-dependent, and range from initial conservative medial management with corticosteroids to an aggressive primary debulking of the affected lacrimal gland. The primary aims of this study were to determine the rate of treatment response, treatment recalcitrance and disease recurrence, and to formulate an approach toward management of idiopathic dacryoadenitis. Secondary aims of this study were to review the histopathologic features of lacrimal gland biopsies to assess the distribution of pathology.
Study Design: This prospective, multi-centre observational clinical chart review identified all patients with the diagnosis of idiopathic dacryoadenitis from various Oculoplastic practices in Toronto, Canada.
Methods: Each patient’s initial presentation, management and treatment outcomes were collected. The rate of treatment response, recalcitrance and disease recurrence was measured and histopathologic features of lacrimal gland biopsies were evaluated for distribution of pathology. Patients were followed over 6 months post completion of therapy to measure recurrent attacks, dry eye symptoms, and/or use of anti-inflammatory medications. Data was analyzed using Fisher exact test (2-tailer) and Student t-test (2-tailed) with statistical significance defined at p<0.05.
Results: Forty-two cases of idiopathic dacryoadenitis have been included. Our study population showed a female preponderance (81% women, 19% men) and a mean age of 50 (+SD 11.9) years. Bilateral lacrimal gland involvement was seen in 40% cases. An even distribution of “classic” dacryoadenitis with moderate inflammation (52.3%) and painless orbital mass effect (47.7%) was seen clinically. Concomitant autoimmune or allergic disease was observed in 52.3% patients. Radiologically, 42.9% patients presented with isolated enlargement of the lacrimal gland. Of those who showed concurrent orbital involvement, inflammation was commonly seen extending to extraocular muscles (66.7%), orbital fat (77.8%) and optic nerve (11.1%). A total of 90% of patients were initiated on prednisone therapy, approximately half (47%) of who relapsed. Most patients required a mean treatment period of 4.8 months (95% CI 3 to 6.6 months). Of these patients, complete resolution seen in 50%, 33.3% became recalcitrant and 16.7% showed incomplete response.
Conclusions: Half of the patients with idiopathic dacryoadenitis showed a complete resolution on oral prednisone therapy. Clinical remission was achieved in 83.3% of the population on oral therapy alone, thereby necessitating debulking surgical or radiation therapy for a minority of patients diagnosed with this entity. Our findings provide an approach to management of idiopathic dacryoadenitis, which will help inform practice decisions in the primary care setting.
