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Cindy Ocran, Louise A. Mawn, Behin Barahimi, Rachel K. Sobel; Effectiveness of direct local infusion of antimicrobial treatment with intraorbital catheters in management of bacterial orbital cellulitis. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2939.
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Orbital cellulitis is a potentially sight-threatening and life-threatening condition. Necrotizing orbital cellulitis with subperiosteal and intraorbital abscesses is on the extreme end of disease morbidity and has led to exenteration. These cases require urgent surgical debridement and drainage with IV antibiotics and multiple trips to the operating room for successive debridements. Based upon a technique described in Kahana and Lucarelli's 2007 paper on sinoorbito-cranial mucormycosis, we have utilized the intraorbital catheter to directly infuse medications into the orbit in these severe bacterial infections. We hypothesize that it is effective in the acute setting for salvaging the eye and orbit and also improves patient outcomes.
Institutional Review Board approval was obtained. A retrospective chart review from 2009 to 2019 identified 13 cases of necrotizing bacterial orbital cellulitis that were managed with IV antibiotics with local infusions of antibiotics with or without hypochlorous acid by way of intraorbital cathethers. We evaluated pre and post-operative vision, motility, globe status, the duration of catheter implantation time, and number of debridements for a descriptive analysis.
The average age on presentation was 55 (range 39-71). Ten of thirteen patients were male. Of the thirteen cases identified, MRSA was the most commonly implicated species (38%), followed by Group F streptococcus (30%). All cases had significant motility defects on presentation. All patients who received an orbital catheter had frank necrosis of orbital tissue with intraorbital and/or subperiosteal abscesses. On average, there were three debridements (range 1-4) per case with a catheter duration of 8 days (range 3-13 days). Hospital stay was approximately 12 days. All patients survived and all globes were salvaged, with no cases of exenteration. Visual acuity improved to 20/20 or had at least 3 lines of improvement in the majority of cases. No visual acuity worsened after treatment. Half of cases had complete resolution of motility deficits.
Local infusion of antimicrobial agents through intraorbital catheters is an effective adjunct to debridement and IV antibiotics in the management of necrotizing bacterial orbital cellulitis. Future study will compare outcomes of patients who get catheter treatment and those that do not.
This is a 2020 ARVO Annual Meeting abstract.
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