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Justin Nathaniel Karlin, Steven A Newman; Orbital cellulitis with subperiosteal abscess: a retrospective study of 11 consecutive cases. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5147.
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Without appropriate treatment, subperiosteal abscess (SPA) in the setting of orbital cellulitis may result in optic neuropathy and vision loss. Treatment often requires surgical intervention. We hypothesize that abscesses located in the superior quadrant are more likely than those in the medial quadrant to require extensive surgical intervention.
The data used in this study were obtained by reviewing all tertiary referral center inpatient admissions for a diagnosis of orbital cellulitis with SPA from March 2009 until August 2015. Charts were reviewed for patient demographics, clinical features, radiographic findings, culture results, intervention (medical only vs. medical/surgical), surgical approach, duration of admission.
Eleven patients were identified that had clinical and radiographic evidence of SPA in the setting of orbital cellulitis. Mean patient age was 12.9 years (range 6.3 to 37.1 years) and most (10 of 11) patients were 18 years old or younger. There were 6 of 11 male patients and 5 of 11 female. All patients had a history of concurrent sinusitis. All abscesses were located either in the superior (5 of 11) or medial (6 of 11) quadrant of the orbit. Of the medial abscesses, 4 of 6 underwent surgery, all of which underwent sinus decompression by the endonasal endoscopic approach only. Of the superior abscesses, 5 of 5 underwent surgery, all of these required both endonasal endoscopic sinus surgery as well as anterior orbitotomy. The average hospital stay was 4.2 days for patients with superior abscesses, and 3.8 days for those with medial abscesses. Culture of abscess aspirates grew bacteria in 6 of 11 cases; of these, all were Gram positive and 5 of 6 specifically grew streptococcal species.
The majority of cases underwent surgical intervention (8 of 11). Patients with abscesses in the superior quadrant all required extensive operative management involving combined endoscopic sinus surgery and anterior orbitotomy. While abscesses in the medial quadrant that underwent surgery were managed by endoscopic sinus decompression alone. There was no clinically significant difference in the average hospital stay for patients with superior versus medial abscesses. The most common bacterial isolates were streptococcal species. Understanding the clinical features of orbital cellulitis with SPA helps guide treatment and prevent complications.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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