Abstract
Purpose :
Current literature suggests there is a role for adjunctive systemic steroid therapy in orbital cellulitis (OC), but the method and timing of administration lacks uniformity. We performed a retrospective observational study to better characterize an optimal regimen for systemic steroids in OC with or without subperiosteal abscess (SPA) formation.
Methods :
We conducted a retrospective search of electronic medical records to identify patients with OC from 2004 to 2022 who received steroid treatment during hospital stay. Data extracted included demographic and baseline clinical characteristics, radiographic evidence of SPA, steroid regimen, and surgical intervention, when performed. Primary outcomes included length of hospital stay (LOS) and final best-corrected visual acuity (BCVA). Statistical analyses were performed using R (R Core Team, 2022). We assessed the impact of route of steroid administration and timing of initiation on outcome variables using t-tests and multivariable linear regressions (MVR). A p-value threshold of < 0.05 was used to indicate statistical significance.
Results :
Of 133 patients with OC who received steroid treatment during their hospital stay, 68 (51.1%) had evidence of SPA on imaging. Non-SPA patients experienced a significantly greater length of stay than SPA patients (7.93 vs. 5.72, p=0.005). 71 (53.4%) patients received intravenous (IV) steroids and 62 (46.6%) received oral without IV therapy (PO only). IV steroid administration was associated with a higher rate of surgery (p=0.001) while patients with diabetes mellitus experienced more frequent PO steroid use (p=0.047). Per MVR, IV therapy was not associated with shorter LOS (p= 0.48) or superior BCVA (p=0.86) when controlling for surgical management. Steroid initiation ranged from 0 to 9 days after presentation (mean 1.22 days, SD 1.56). The 37 (27.8%) patients who received steroids prior to hospital day 2 experienced shorter LOS (OR: -2.07 [-3.71, -0.43]).
Conclusions :
Intravenous steroid administration, compared to oral therapy, may not impact LOS or final BCVA in OC patients regardless of surgical intervention. Initiating adjunctive steroid therapy prior to hospital day 2 may contribute to shortened LOS. Further research is warranted to assess the safety and impact of early steroid use in OC.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.