Abstract
Purpose :
Orbital cellulitis (OC)-related subperiosteal (SPA) and orbital abscess (OA) formation are vision- and life-threatening conditions. Considerations and consequences of SPA and OA as distinct processes are poorly defined. We performed a retrospective cohort study to compare clinical features, management, and outcomes between adolescent and adult patients with SPA and those with OA.
Methods :
A retrospective chart review was conducted using a medical record search of OC ICD codes from 1/1/2000 to 9/10/2022. Charts were screened for those with radiographic evidence of SPA or OA. Exclusion criteria included age younger than 9 years and those with simultaneous SPA and OA. Demographic and clinical variables were extracted. Primary outcomes included rates of surgical intervention, reoperation, and readmission; as well as length of hospital stay (LOS) and final vision. Fishers Exact, Mann-Whitney U, and Logistic Regression tests were used to compare OA and SPA cohorts with an α of 0.05 to indicate significance.
Results :
A total of 120 patients, 91 with SPA and 29 with OA, met criteria. The SPA group was 61.5% male with a mean age of 29.9 ± 23.4 years, while the OA group was 48.3% male with a mean age of 46.7 ± 18.3 years (p<0.001, p<0.001). Sinusitis was the most common risk factor for both (92.3% SPA, 65.5% OA, p<0.001), and OA was more likely to occur in association with orbital trauma (34.5% vs 13.2%, p=0.014) or implanted hardware (10.3% vs 1.1%, p=0.043). OA patients more often presented with a relative afferent pupillary defect (17.2% vs 4.4%, p=0.027) and vision worse than 20/50 (55.2% vs 25.3%, p<0.001). While rates of surgery (71.4% vs 79.3%, p=0.717) were similar, SPA more commonly underwent combined external and endoscopic drainage (29.6% vs 4.3%, p=0.035) while OA more commonly underwent external drainage alone (78.3% vs 15.4%, p<0.001). OA was associated with a higher reoperation rate (18.6% vs 45.8%, p=0.014). Visual outcomes, LOS, and readmission rates were similar between groups.
Conclusions :
History of orbital trauma or implanted hardware may carry greater risk of OA than SPA formation in OC. OA may present with more severe ophthalmic impairment than SPA and be treated with external drainage alone rather than combined surgery. With appropriate management, clinical outcomes are similarly favorable for SPA and OA.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.