肌炎型特发性眼眶炎性假瘤

目的探讨肌炎型眼眶特发性炎性假瘤的临床特点.方法回顾分析我院1978年1月～1999年12月特发性眼眶炎性假瘤病例,每例均有完整的临床特点、影像表现、诊断和治疗结果等记录.随访时间为1周到9年(平均4个月).结果　209例眼眶特发性炎性假瘤中,16例(8%)属于肌炎型眼眶特发性炎性假瘤.其中男6例,女10例;右眼6例,左眼7例,双眼3例;平均就诊年龄39岁.以眼球运动受限与斜视(87.5%)、复视(68.8%)、眼球突出(62.5%)为最常见表现,眼部充血(43.8%)和疼痛(43.8%)是与其它类型斜视不同的重要特点.各条眼外肌中,上直肌受累最常见(62.5%),其次为外直肌(43.8%),内直肌(31%)和下直肌(31%).经全身激素或激素联合局部放射治疗后,治愈率为56%,有效率为75%,复发率为75%.结论肌炎型是特发性眼眶炎性假瘤中较少见的临床亚型之一,以上直肌受累最常见,其次为外直肌、内直肌与下直肌.全身激素或激素联合放射治疗的治愈率只有56%,而复发率高达75%.如何提高治愈率与减少复发率是今后努力的方向.

Myositis of idiopathic orbital inflammatory pseudotumor

Objective To observe the clinical characters in patients with a diagnosis of myositis of idiopathic orbital inflammatory pseudotumor. Methods 209 patients with idiopathic orbital inflammatory pseudotumor(IOIP) from Jan 1, 1978 to Dec 31, 1999 in Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat sen University of Medical Sciences were evaluated retrospectively, with special attention to their clinical findings, image features, diagnosis and therapeutic effect. Follow up period ranged from one week to nine years (average 4 months). Results 16 out of 209 IOIP cases belonged to the clinical subtype of myositis (8%). Including male 6, female 10, right eye 6, left eye 7, and both eyes 3. The mean age was 39 years. Ocular motility resriction and strabismus (87 5%), diplopia (68 8%), and proptosis (62 5%) were the most common presenting signs. The important differential signs were ocular congestion (43 8%) and pain (43 8%). The superior rectus was the most involved muscle (62.5%), next in order the lateral rectus (43.8%), medial rectus (31%) and inferior rectus (31%). All patients underwent either systemic corticosteroids or a combined oral corticosteroids and local radiotherapy. In our series, the full recovery response rate was 56% and the effective rate was 75%. However, the recurrent rate was as high as 75%. Conclusions Myositis was one of the uncommon clinical subtypes of IOIP, Superior rectus was the most involved muscle, followed by lateral, medial and inferior rectus. After systemic corticosteroids and/or local radiotheraphy, the full recovery response rate was as low as 56% and the recurrente rate was as high as 75%. How to enhance the therapeutic effect and lower the recurrent is an important problem.