alexa Clinical Course of a Pediatric Graves’ Extraocular Myopathy Patient Followed-up by Magnetic Resonance Imaging
ISSN: 2155-9570

Journal of Clinical & Experimental Ophthalmology
Open Access

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Case Report

Clinical Course of a Pediatric Graves’ Extraocular Myopathy Patient Followed-up by Magnetic Resonance Imaging

Hirohiko Kakizaki1*, Yasuhiro Takahashi1, Akihiro Ichinose2 and Masayoshi Iwaki1
1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
2Department of Plastic Surgery, Kobe University, Chuo, Kobe, Hyogo 650-0017, Japan
Corresponding Author : Hirohiko Kakizaki
Department of Ophthalmology
Aichi Medical University, Nagakute
Aichi 480-1195, Japan
Tel: +81-561-62-3311 (ext. 2181)
Fax: +81-561-63-7255
E-mail: [email protected]
Received: January 14, 2011; Accepted: March 07, 2011; Published: March 09, 2011
Citation: Kakizaki H, Takahashi Y, Ichinose A, Iwaki M (2011) Clinical Course of a Pediatric Graves’ Extraocular Myopathy Patient Followed-up by Magnetic Resonance Imaging. J Clinic Experiment Ophthalmol 2:144. doi:10.4172/2155-9570.1000144
Copyright: © 2011 Kakizaki H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

A 14-year-old male patient with Graves' orbitopathy presented with a downward gaze restriction in the left eye. Magnetic resonance imaging (MRI) revealed an edematous left superior rectus muscle. Retrobulbar injection of triamcinolone acetonide (20 mg) was administered in the left orbit. However, edema was still evident in the left superior rectus muscle on MRI, 3 months after the injection, and new inflammation was detected in bilateral inferior rectus muscles. The patient then underwent three cycles of steroid pulse therapy (1 cycle: methylprednisolone 10 mg/kg/ day × 3 days). One week after the steroid pulse therapy, eye movement was improved and the inflammation in the left superior rectus muscle and the bilateral inferior rectus muscles subsided on MRI. However, the patient noticed diplopia during upward gaze 2 months later, and MRI showed recurrence of edematous changes in bilateral inferior rectus muscles. The patient was treated with the same protocol of steroid pulse therapy. One month after the second steroid pulse therapy, ocular motility was improved and the inflammation in both inferior rectus muscles had almost resolved. This case illustrates the detailed clinical course of edematous extraocular myopathy in a pediatric Graves' orbitopathy patient, followed-up by successive MRI.

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