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K.G. Yen, M.T. Yen; The Effect of Corticosteroids in the Acute Management of Pediatric Orbital Cellulitis with Subperiosteal Abscess . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5603.
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Purpose: To evaluate the effect of intravenous (IV) corticosteroids in the acute treatment of pediatric orbital cellulitis with subperiosteal orbital abscess. Methods: A retrospective review was performed of inpatients treated for orbital cellulitis with subperiosteal orbital abscess between January 2001 and August 2003 at the Texas Children’s Hospital. The use of corticosteroids, length of hospital stay, need for surgical drainage, treatment course, and clinical outcomes were reviewed. T–test and Fisher exact test analysis were calculated to evaluate statistical significance. Results: A total of 24 patients were identified ranging in age from 11 days to 15 years old. One patient was excluded because the corticosteroids were not given in the acute treatment of the orbital cellulitis. Twelve patients received IV corticosteroids and eleven patients did not receive corticosteroids during their hospitalizations. Length of hospitalization between the patients treated with and without IV corticosteroids was not significantly different (p=0.26) although there was a slight trend toward shorter hospitalizations in the patients treated with IV corticosteroids (median 6.5 days versus 10 days). 4/12 patients treated with IV corticosteroids required orbitotomy for drainage of the abscess and, 6/11 patients treated without IV corticosteroids required surgical drainage (p=0.20). 2/12 patients treated with corticosteroids required IV antibiotics after discharge, while 7/11 in the group not treated with corticosteroids required IV antibiotics after discharge (p=0.03). All patients in both groups had complete resolution of their subperiosteal abscesses. Conclusions: The use of IV corticosteroids does not adversely affect clinical outcomes and may be beneficial in the treatment of pediatric orbital cellulitis with subperiosteal abscess. Median length of hospitalization and need for surgical drainage of the orbital abscess were reduced and approached statistical significance in patients treated with corticosteroids. Patients treated with IV corticosteroids were less likely to require IV antibiotic treatment at discharge (p=0.03). Review of our data suggests that a prospective randomized trial may be warranted to further clarify the role of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.
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