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Year : 2011  |  Volume : 4  |  Issue : 1  |  Page : 21-24

Role of antimetabolites in recalcitrant idiopathic orbital inflammatory syndrome

Department of Ophthalmology, St John's Medical College Hospital, Bangalore - 560 034, India

Correspondence Address:
Yamini Priya
Department of Ophthalmology, St John's Medical College, Bangalore - 560 034
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-620X.77658

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Background : High-dose systemic steroids are the primary modality of treatment for idiopathic orbital inflammatory syndrome (IOIS). Occasionally patients experience a relapse of symptoms on tapering steroids or require large doses of steroid, predisposing them to the adverse effects of steroids. Aim : We present our experience with the management of three patients with recalcitrant IOIS, with immunosuppressive therapy, using antimetabolites. Materials and Methods : A retrospective review of the medical records of the patients being reported. Results: Two patients were treated with Methotrexate and one with Azathioprine for a duration of 6-24 months. Two patients were symptom-free three years after stopping the medication. One was doing well clinically with methotrexate therapy alone, when he was lost to follow-up after six months. No adverse effects of immunosuppressive therapy were encountered. Conclusion : High-dose systemic steroid therapy is the first-line treatment for IOIS, but in refractory or steroid-dependent cases, immunosuppressive therapy with antimetabolites is a safe and effective treatment alternative to steroids. However, treatment with antimetabolites warrants close monitoring for complications like bone marrow suppression and liver dysfunction, especially because long-term treatment is required.

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