Idiopathic Enlargement of the Extraocular Muscles in Young Patients: A Case Series




We read with great interest the recent report by Sharma and associates describing 6 patients they believe have idiopathic enlargement of the rectus muscles. We would like to share some thoughts generated after carefully reading this paper. Review of the radiography presented by the authors does not seem conclusive to consider the rectus muscles enlarged, especially the coronal images for Cases 2 and 5. In addition, it may have been more appropriate to use either axial or coronal sections for Case 6 rather than a sagittal image to be able to compare the rectus muscles to uninvolved rectus muscles on the ipsilateral and contralateral sides. Also, we would be curious to know the serologic work-up conducted in their cohort, with specific emphasis on complete blood count, thyroid-stimulating immunoglobulin, angiotensin-converting enzyme, lysozyme, and serum IgG4. Without these diagnostic tests we do not feel that the patients described could be categorized as having idiopathic disease. Finally, in the case descriptions it is unclear whether biopsies were done on all patients, as would be necessary for complete work-up. Furthermore, we wonder if the biopsy technique was actually diagnostic. Some of the imaging shown depicts the enlargement of the rectus muscle to be in the posterior orbit. A biopsy of this tissue likely would require an orbitotomy approach and a large enough sample would be needed for adequate histopathologic interpretation. The authors should detail their surgical biopsy technique to confirm that the area of pathology was sampled properly. One case described a muscle biopsy that was 1.0 × 3.0 mm in size. This seems a bit small in a patient with an atypical clinical presentation where proper histologic investigation may be the most critical study in the diagnostic work-up.

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Jan 6, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Idiopathic Enlargement of the Extraocular Muscles in Young Patients: A Case Series

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