Abstract
Purpose :
The impact and indication for systemic steroid administration in the management of orbital cellulitis complicated by orbital subperiosteal abscess (SPA) remains poorly characterized. We conducted a retrospective comparative cohort study to assess the role of systemic steroids in SPA treatment.
Methods :
ICD-9 and ICD-10 billing codes and radiographic imaging records were used to identify patients with orbital cellulitis with SPA between 2003 and 2022. Data collected from patient records included demographics and baseline clinical characteristics. Patients were divided into steroid (S) and non-steroid (NS) cohorts. Primary outcomes included surgical intervention rate, mean length of hospital stay (LOS), and final best-corrected visual acuity (BCVA). Subgroup analyses were performed within S and NS cohorts using R software (R Core Team, 2020). Univariate and multivariable logistic regressions assessed factors associated with steroid use; multivariable linear regressions assessed the effect of steroid use on primary outcomes. A p-value threshold of < 0.05 was used to indicate statistical significance.
Results :
Of the 146 patients with orbital SPA, 68 (46.6%) received systemic steroids during hospitalization. Baseline BCVA and intraocular pressure (IOP) were similar between S and NS cohorts (logMAR 0.32 in S group vs 0.23 in NS group; p=0.45; 21 mmHg in both), as well as rates of sinusitis, immune suppression, and diabetes mellitus. Surgical intervention rate was higher in the steroid cohort, but did not reach significance (64.7% in the S group vs 59.0% in the NS group, p=0.48). Among patients who underwent surgery, mean LOS was similar across S and NS groups (6.43 days in S vs. 6.21 days in NS; p=0.83). Similarly, among patients who did not undergo surgery, LOS was not significantly different between the S and NS groups (4.42 days in S vs 4.07 days in NS; p=0.46). Steroid therapy did not affect LOS (OR: 2.99, CI [0.65 - 5.33]) or change in BCVA (S –0.10 vs NS 0.16 change in logMAR; p=0.37) when controlled for surgery and immunosuppressed status, both of which were associated with longer LOS.
Conclusions :
Our results suggest that systemic steroid therapy does not significantly affect surgical intervention rate, LOS, and change in BCVA in orbital cellulitis complicated by SPA. Further investigation is warranted to optimize evidence-based management and minimize treatment risk in SPA.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.