The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A.
Ophthalmic Plast Reconstr Surg. 2024;40(2):161-166. doi: 10.1097/IOP.0000000000002495. Epub 2023 Aug 15.
To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA).
A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision.
A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar.
OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.
比较伴有骨膜下脓肿（SPA）和伴有眼眶脓肿（OA）的眶蜂窝织炎患者的临床特征、治疗方法和结局。
通过病历检索，对 2000 年 1 月 1 日至 2022 年 12 月 31 日在一家三级护理中心进行了一项回顾性研究，以确定眶蜂窝织炎患者。对 SPA 或 OA 的影像学证据进行筛查。比较两组患者的人口统计学数据和临床表现。主要结局比较包括手术干预、再次手术和再入院率；以及住院时间和最终视力。
共有 189 名患者符合标准，其中 162 名 SPA 和 27 名 OA。OA 组（平均 46.5±18.6 岁）比 SPA 组（平均 19.1±21.4 岁）年龄更大。SPA 组合并鼻窦炎的比例显著更高（95.7% SPA；70.4% OA；p<0.001），而 OA 更可能与眼眶外伤（29.6% vs. 8.0%；p=0.003）、植入物（11.1% vs. 0.6%；p=0.005）和合并糖尿病（22.2% vs. 4.3%；p=0.001）相关。OA 患者更常出现相对传入性瞳孔缺陷（21.7% vs. 3.9%；p=0.005）、视力低于 20/50（42.3% vs. 16.2%；p=0.005）和耐甲氧西林金黄色葡萄球菌感染（20.8% vs. 5.8%；p=0.036）。OA 与更高的再次手术率（47.8% vs. 21.3%；p=0.019）、再入院率（18.5% vs. 5.6%；p=0.047）和随访时眼球运动受限（4.3% vs. 25%；p=0.013）相关；而住院时间和最终视力相似。
OA 可能会影响与 SPA 相比具有不同风险因素特征的老年人群。OA 可能会导致更严重的功能障碍，因此需要更积极的治疗来获得与 SPA 相似的视力结果。
