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PURPOSE: Phenylephrine testing prior to Müller muscle conjunctival resection has traditionally been used to predict postoperative outcomes. The purpose of this study is to determine if preoperative phenylephrine testing impacts postoperative changes in eyelid position. METHODS: In this multicenter cross-sectional cohort study, 270 eyelids of participants with involutional ptosis and levator function >12 mm who underwent Müller muscle conjunctival resection were divided into 2 comparison groups. Participants who had preoperative phenylephrine testing served as the control group and those who did not were the study group. The primary outcome measure was postoperative marginal reflex distance from the upper eyelid margin (marginal reflex distance 1 [MRD1]) at the latest follow-up visit. Secondary outcomes included change in MRD1, reoperation rate, and predictive capacity of preoperative phenylephrine testing. RESULTS: Of the 270 eyelids that underwent Müller muscle conjunctival resection, 116 eyelids served as controls and 154 were in the study group. Mean age of participants was 62.6 years. Levator function, resection length, preoperative MRD1, change in MRD1, and latest postoperative MRD1 measures when compared in the control and study groups demonstrated no significance (p > 0.05) via 2-tailed t-test. Postoperative MRD1 was correctly predicted within 1 mm for 60.2% of eyelids that underwent preoperative phenylephrine testing. CONCLUSIONS: Preoperative phenylephrine testing does not significantly predict postoperative eyelid elevation following Müller muscle conjunctival resection. Surgeons may thereby reassess the utility of preoperative phenylephrine testing given the lack of influence on surgical outcomes.
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PURPOSE: To compare postoperative infection (PI) rates using sterile and clean-boxed gloves in office-based oculoplastic procedures. METHODS: Prospective, comparative study of patients undergoing oculoplastic procedures by a single surgeon (RS) in an office-based procedure room between October 2018 and September 2020. Participants included were 18 years or older. Excluded were patients on oral antibiotics within 2 weeks before the procedure, had a follow-up period of less than 1 week, had a contaminated wound, had complex reconstructions, or had multiple simultaneous procedures performed. Oculoplastic procedures were performed using either sterile or clean-boxed gloves. The main outcome measure was the frequency of postoperative infection. RESULTS: Three thousand one hundred twenty-nine patients, 1,815 (58%) of whom were women, with a mean age of 60 (18-102) years were included. One thousand five hundred seventy procedures were performed with sterile gloves, while 1,559 were performed with clean-boxed gloves. The patients in the 2 groups were similar in age, gender, and number of high-risk individuals. One patient in the sterile glove group who underwent upper blepharoplasty (0.064%) and one patient (0.064%) in the clean-boxed glove group who had an external levator advancement blepharoptosis repair developed PI. Neither patient had risk factors for infection, and both infections resolved after 1 week of oral amoxicillin-clavulanate 875/125 mg twice daily. CONCLUSIONS: In minimally complex in-office oculoplastic procedures, using sterile versus clean-boxed gloves resulted in similar low infection rates in this large cohort. The healthcare benefits may not outweigh the costs of using sterile gloves universally for office-based oculoplastic procedures.
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Blefaroplastia , Infecção da Ferida Cirúrgica , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Prospectivos , Esterilização , Luvas Cirúrgicas , AmoxicilinaRESUMO
PURPOSE: Teprotumumab, an insulin-like growth factor 1 receptor monoclonal antibody, is FDA-approved to treat thyroid eye disease (TED). The initial clinical trials excluded patients with previous orbital irradiation, surgery, glucocorticoid use (cumulative dose >1 gm), or prior biologic treatment. Information on the use of teprotumumab for patients who failed prior therapy is limited. Our purpose is to characterize the efficacy of teprotumumab for the treatment of recalcitrant TED. METHODS: This is a multicenter retrospective study of all patients treated with teprotumumab for moderate-to-severe TED after failing conventional therapy with corticosteroids, orbital radiation, surgical decompression, biologics, or other steroid-sparing medications. Treatment failure was defined as an incomplete response to or reactivation after previous treatment. Only patients who received at least 4 infusions of teprotumumab were included in the analysis. Primary outcome measures comprised proptosis response (≥2 mm reduction in the study eye without a similar increase in the other eye), clinical activity score (CAS) response (≥2-point reduction in CAS), and diplopia response (≥1 point improvement in Gorman diplopia score in patients with baseline diplopia) following treatment. Adverse events and risk factors for recalcitrant disease were also evaluated. RESULTS: Sixty-six patients were included in this study, 46 females and 20 males. Average age was 59.3 years (range 29-93). The mean duration of disease from TED diagnosis to first infusion was 57.8 months. The proptosis, CAS, and diplopia responses in this recalcitrant patient population were 85.9%, 93.8%, and 69.1%, respectively. Patients experienced a mean reduction in proptosis of 3.1 ± 2.4 mm and a mean improvement in CAS of 3.8 ± 1.6. Patients who underwent prior decompression surgery experienced a statistically significant decrease in diplopia response (46.7% vs. 77.5%, p = 0.014) and proptosis response (75.0% vs. 90.9%, p = 0.045) when compared with nondecompression patients. Additionally, there were no significant differences in proptosis, CAS, and diplopia responses between patients with acute (defined as disease duration <1 year) versus chronic (disease duration ≥1 year) TED. While most adverse events were mild to moderate, 4 patients reported serious adverse events related to persistent hearing loss. CONCLUSIONS: Patients with recalcitrant TED demonstrated a significant improvement after teprotumumab in each of the primary study outcomes. The degree of proptosis reduction, diplopia response, and CAS improvement in the recalcitrant group were similar to those of treatment-naïve patients from the pivotal clinical trials. Patients with a prior history of orbital decompression, however, demonstrated poor improvement in diplopia and less reduction in proptosis than surgery naïve patients. These results indicate that teprotumumab is a treatment option for the treatment of patients with TED recalcitrant to prior medical therapies.
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PURPOSE: In response to the coronavirus (COVID-19) pandemic, teprotumumab production was temporarily halted with resources diverted toward vaccine production. Many patients who initiated treatment with teprotumumab for thyroid eye disease were forced to deviate from the standard protocol. This study investigates the response of teprotumumab when patients receive fewer than the standard 8-dose regimen. METHODS: This observational cross-sectional cohort study included patients from 15 institutions with active or minimal to no clinical activity thyroid eye disease treated with the standard teprotumumab infusion protocol. Patients were included if they had completed at least 1 teprotumumab infusion and had not yet completed all 8 planned infusions. Data were collected before teprotumumab initiation, within 3 weeks of last dose before interruption, and at the visit before teprotumumab reinitiation. The primary outcome measure was reduction in proptosis more than 2 mm. Secondary outcome measures included change in clinical activity score (CAS), extraocular motility restriction, margin reflex distance-1 (MRD1), and reported adverse events. RESULTS: The study included 74 patients. Mean age was 57.8 years, and 77% were female. There were 62 active and 12 minimal to no clinical activity patients. Patients completed an average of 4.2 teprotumumab infusions before interruption. A significant mean reduction in proptosis (-2.9 mm in active and -2.8 mm in minimal to no clinical activity patients, P < 0.01) was noted and maintained during interruption. For active patients, a 3.4-point reduction in CAS ( P < 0.01) and reduction in ocular motility restriction ( P < 0.01) were maintained during interruption. CONCLUSIONS: Patients partially treated with teprotumumab achieve significant reduction in proptosis, CAS, and extraocular muscle restriction and maintain these improvements through the period of interruption.
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COVID-19 , Exoftalmia , Oftalmopatia de Graves , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Oftalmopatia de Graves/tratamento farmacológico , Estudos TransversaisRESUMO
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of lymphoma, involving the lumen of predominantly small blood vessels, especially capillaries. The orbit is an uncommon site of involvement for IVLBCL, and diagnosis before autopsy is even more rare as most cases are established post-mortem. Herein, the authors describe a 73-year-old male who presented with 3 weeks of progressive bilateral ptosis and ophthalmoplegia. Computed tomography (CT) and subsequent magnetic resonance imaging (MRI) revealed diffuse abnormal thickening and enhancement of bilateral orbital apices, superior orbital fissures, and cavernous sinus, along with persistent focal opacification of the left frontal and ethmoid sinuses. Infectious and inflammatory workup of serum and cerebrospinal fluid was negative. Ethmoidal sinus and middle turbinate biopsy confirmed intravascular large B-cell lymphoma and the patient was started on R-CHOP chemotherapy regimen.
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Linfoma Difuso de Grandes Células B , Oftalmoplegia , Masculino , Humanos , Idoso , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Oftalmoplegia/diagnóstico , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/etiologia , BiópsiaRESUMO
PURPOSE: The authors report on a 10-year experience of correcting tarsal ectropion using a combined method of modified Bick eyelid tightening (MBLT) and inverting sutures. METHODS: Retrospective, interventional case series of consecutive patients with tarsal ectropion who underwent MBLT and inverting sutures by a single surgeon (RS) between July 2010 and July 2020. Thirty-four patients, 24 of whom were female, with a mean age of 81.6 years (range 59-92) were included. Eight patients had bilateral disease. All procedures were performed under local anesthesia in an office setting. Treatment success was defined by eyelid position, symptoms, and need for reoperation. RESULTS: Thirty-one patients (91%) had a successful outcome. Three patients (9%) had satisfactory results with improved symptoms and mild residual ectropion, for which further surgery was not required. No patients had poor results. The mean follow-up time was 4.5 months (range 3-11 months). The inverting sutures were well tolerated in all cases and none had to be removed due to ocular surface discomfort. There were no visible scars from the inverting sutures in any patient at postoperative month 3. CONCLUSIONS: A combination of eyelid tightening using MBLT and inverting sutures is a simple and effective treatment for lower eyelid tarsal ectropion with minimal tissue dissection.
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Ectrópio , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Ectrópio/cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Pálpebras/cirurgia , SuturasRESUMO
PURPOSE: To review the demographics, clinical features, and response of orbital squamous cell carcinoma treated with cemiplimab. METHODS: This is a retrospective multi-institutional series. Patient characteristics, drug dosing, duration, and response to treatment were evaluated. RESULTS: The study cohort consisted of 11 patients from 5 institutions. All patients received a regimen of 350 mg q 3 weeks and an average of 11.2 cycles (SD 5.8). No patient experienced significant side effects requiring treatment or cessation of cemiplimab. Complete response was achieved in 9 patients (82%) treated with cemiplimab. CONCLUSIONS: Immune checkpoint inhibitors, such as cemiplimab provide a globe-sparing option for the treatment of orbital squamous cell carcinoma. It is important to consider these agents especially when orbital exenteration is the alternative.
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Carcinoma de Células Escamosas , Neoplasias Orbitárias , Neoplasias Cutâneas , Anticorpos Monoclonais Humanizados/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Humanos , Neoplasias Orbitárias/tratamento farmacológico , Estudos Retrospectivos , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
PURPOSE: Well-differentiated neuroendocrine or carcinoid tumors are found most commonly in the gastrointestinal tract. When metastatic to the orbit, they tend to have a propensity for the extraocular muscles. The purpose of this study was to better understand the diversity in presentation of orbital carcinoid disease and to determine predictors for survival. METHODS: In this observational cross-sectional cohort study, data from 8 tertiary orbital practices were compiled. Demographic, clinical, pathologic, American Joint Committee on Cancer stage and grade, imaging, and management data were extracted for all the patients. Descriptive statistics were calculated. Subgroups were compared utilizing analysis of variance analyses and Kaplan-Meier curves. Time to progression and disease-specific and overall mortality were calculated. Comparisons were performed for the following a priori pairs: unknown versus known primary tumor, single versus multiple extraocular muscle involvement, unilateral versus bilateral orbital disease, extraocular muscle versus other orbital involvement, and excisional versus incisional surgery. RESULTS: A total of 28 patients with carcinoid tumors of the orbit were identified. Of these, 57.1% of patients were female, the mean age at diagnosis of the primary tumor was 58.8 years and the mean age at diagnosis of orbital disease was 62.6 years. At primary presentation, all patients were American Joint Committee on Cancer stage III or IV and 21.4% demonstrated carcinoid syndrome. Muscle involvement was noted in 78.6% of patients, and of these, 72% were noted to have single muscle disease. Eight patients had no primary tumor identified; 3 of these 8 demonstrated disseminated disease at the time of diagnosis. The overall 5-year survival rate was 81.8% from diagnosis of primary tumor and 50% from diagnosis of orbital disease. Subgroup analysis revealed that patients with unilateral orbital disease when compared with bilateral orbital disease had a longer progression-free survival and time to death from all causes (p = 0.025). Patients with disease localized to the orbit at presentation had longer time to death than those with disseminated disease. Treatment with surgery, radiation, or octreotide did not appear to affect survival. Patients managed with systemic chemotherapy had a shorter time of survival than the rest of the group. All other subgroup comparisons were not found to be statistically significant. CONCLUSIONS: Neuroendocrine tumors of the orbit represent a wide spectrum of disease, with some cases being part of disseminated disease, while others being localized presentations. This heterogeneity may be responsible for the slightly higher overall survival in these patients than others with metastatic carcinoid tumors in other locations.
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Tumor Carcinoide , Neoplasias Orbitárias , Tumor Carcinoide/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida , Órbita , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/terapiaRESUMO
PURPOSE: To describe the demographics, clinical presentation, treatment, and outcomes of a rare cohort with simultaneous orbital and intracranial abscesses. METHODS: A historical cohort study of 17 patients with simultaneous orbital and intracranial abscesses between 2010 and 2018 was performed. The demographics, location of abscesses, treatment, and outcomes of these patients were analyzed. RESULTS: The mean age was 26.9 years (range 5-83 years). Fourteen patients (82%) were male. In this cohort, the most common orbital abscess location was the superior orbit, involved in 14 patients (82%). The most common site of intracranial abscess was the frontal lobe, involved in 16 patients (94%). Concurrent sinus disease was present in 16 patients (94%). Surgical evacuation was the standard of treatment, with 94% of patients undergoing at least one surgical procedure. Streptococcus species were the most common, isolated from 6 sinus cultures (43%), 3 orbitotomy cultures (21%), and 4 craniectomy cultures (36%). Staphylococcus species were also common. Most patients (94%) had stable or improved mental status and visual function at the conclusion of their treatment. CONCLUSIONS: Simultaneous orbital and intracranial abscesses are rare. Local invasion from the orbit into the intracranial space may occur from direct spread, thus superior orbital abscesses pose the greatest risk for intracranial spread. Additional factors such as infection with Streptococcus and Staphylococcus species as well as male sex appear to be risk factors for intracranial spread. For those who develop intracranial abscesses, young age and absence of seizures or altered mental status at presentation may be associated with favorable outcomes.
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Abscesso , Doenças Orbitárias , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
PURPOSE: While generally reducing morbidity and mortality, TASER® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to be significant eye injury but no analysis of the mechanisms or suggested treatments has been published. METHODS: We used a biomechanical model to predict the risk of eye injury as a function of distance from the weapon muzzle to the eye. We compared our model results to recently published epidemiological findings. We also describe the typical presentation and suggest treatment options. RESULTS: The globe rupture model predicted that a globe rupture can be expected (50% risk) when the eye is within 6â¯m of the muzzle and decreases rapidly beyond that. This critical distance is 9â¯m for lens and retinal damage which is approximately the range of the most common probe cartridges. Beyond 9â¯m, hyphema is expected along with a perforation by the dart portion of the probe. Our prediction of globe rupture out to 6â¯m (out of a typical range of 9â¯m) is consistent with the published risk of enucleation or unilateral blindness being 69⯱â¯18%, with an eye penetration. CONCLUSIONS: Significant eye injury is expected from a penetration by an electrical weapon probe at close range. The risk decreases rapidly at extended distances from the muzzle. Not all penetrating globe injuries from electrical weapon probes will result in blindness.
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Lesões por Armas de Eletrochoque/patologia , Ferimentos Oculares Penetrantes/patologia , Adolescente , Adulto , Fenômenos Biomecânicos , Cegueira/etiologia , Cegueira/patologia , Enucleação Ocular , Ferimentos Oculares Penetrantes/etiologia , Feminino , Balística Forense , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Polícia/legislação & jurisprudência , Estados Unidos , Adulto JovemRESUMO
PURPOSE: A risk assessment score for metastasis based on age, tumor size, and mitotic figures has been suggested for nonorbital solitary fibrous tumor (SFT)/hemangiopericytoma. The authors herein examine the clinicopathological features of recurrent and metastatic orbital SFT and evaluate the existing risk assessment score for orbital SFT. METHODS: The American Society of Ophthalmic Plastic and Reconstructive Surgery Oncology Database was queried for patients with recurrent or malignant orbital hemangiopericytoma/SFT. The medical records were reviewed for clinical and pathologic findings, treatments, and outcomes. RESULTS: Eight patients from 3 institutions were identified with recurrent orbital hemangiopericytoma/SFT. Median age at diagnosis was 59 years, and 4 patients were women. The mean size of tumor was 2.1 ± 1.1 cm. All patients were initially treated with surgery and experienced local recurrence after a median of 4 (range 0.5-10) years. Five patients were treated with orbital radiation. Two patients also developed distant metastases and eventually died of their disease. Median Ki-67 was 5% (range 1-65%) and 5 mitotic figures/10 high-power fields (range 2-30). The previously described risk stratification model for nonorbital SFT did not correlate with the propensity to develop metastases in this cohort; however, both patients with distant metastasis had > 4 mitotic figures /10 high-power fields. CONCLUSIONS: In this cohort of recurrent orbital hemangiopericytoma/SFT, median time to recurrence was 4 years underscoring the importance of careful continued follow-up. The current risk stratification models have limited use for orbital lesions, mostly due to the fact that orbital SFTs are smaller than even the smallest size criteria in this risk assessment model.
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Hemangiopericitoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Orbitárias/patologia , Tumores Fibrosos Solitários/patologia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Seguimentos , Hemangiopericitoma/cirurgia , Humanos , Incidência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Procedimentos Cirúrgicos Oftalmológicos , Neoplasias Orbitárias/cirurgia , Estudos Retrospectivos , Tumores Fibrosos Solitários/cirurgia , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
PURPOSE OF REVIEW: Periocular sebaceous cell carcinoma is a rare malignancy that is often misdiagnosed leading to increased morbidity and mortality. This review aims to describe current knowledge on the disease to aid clinicians in timely diagnosis and treatment. RECENT FINDINGS: New research has shown that the diagnosis of sebaceous cell carcinoma can be aided with immunohistochemical stains. A revision in the American Joint Committee on Cancer staging system incorporates new tumor size classifications in the staging of eyelid carcinomas. Wide local excision and Mohs micrographic surgery continue to represent the standard of care for initial treatment of localized disease. SUMMARY: The current review highlights diagnostic and treatment modalities to allow clinicians to make timely diagnosis and tailor treatment plans for individual patient presentations.
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Adenocarcinoma Sebáceo , Erros de Diagnóstico , Técnicas de Diagnóstico Oftalmológico , Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Neoplasias Cutâneas/diagnóstico , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/epidemiologia , Adenocarcinoma Sebáceo/cirurgia , Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/epidemiologia , Neoplasias Palpebrais/cirurgia , Saúde Global , Humanos , Cirurgia de Mohs , Morbidade/tendências , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias das Glândulas Sebáceas/epidemiologia , Neoplasias das Glândulas Sebáceas/cirurgia , Taxa de Sobrevida/tendênciasRESUMO
PURPOSE: To describe a minimally invasive, sutureless, small incision surgical technique for the treatment of subconjunctival orbital fat prolapse (SOFP) performed using local anesthesia in an office setting. METHODS: Retrospective study of the surgical outcome of 45 patients with either bilateral or unilateral SOFP treated by a single surgeon (R.S.) between July 2010 and February 2015. RESULTS: Forty-five patients (39 male, 6 female) had a mean age of 67 years. Fat prolapse was bilateral in 23 patients (51%). A total of 68 eyes were operated on. All surgeries were without any intra- or postoperative complications such as infection, dry-eye symptoms, ocular motility impairment, or recurrence with a mean follow up of 37 months. All patients had a favorable postoperative cosmetic improvement. CONCLUSIONS: The authors propose an office-based, cost-effective, minimally invasive, sutureless technique for treating SOFP with local anesthesia in a safe and effective manner. The lack of complications or recurrence with an adequate follow-up period following this technique is encouraging. Surgeons should consider this technique in the surgical correction of SOFP.
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Tecido Adiposo/cirurgia , Túnica Conjuntiva/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças Orbitárias/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos sem Sutura/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Topical timolol has been increasingly demonstrated to be an effective treatment for pyogenic granulomas (PG). The authors review the treatment outcomes of 17 patients with ocular PG treated with topical timolol. METHODS: Retrospective interventional study of 17 patients with ocular PGs treated with timolol 0.5% solution. Patient demographics, clinical features, treatment response, and recurrence were noted. RESULTS: Nine females and 8 males with a mean age of 23 years (range, 3-67 years) were included. Mean duration of disease prior to treatment was 3.81 months (range, 0.25-11 months). Etiologies included chalazia (12 cases, 71%), postsurgical (4, 24%) and trauma (1, 6%). Five patients (29%) had treatment with topical steroids prior to presentation. Fifteen patients (88%) had PG located on the palpebral conjunctiva and 2 (12%) involving the bulbar conjunctiva. Mean lesion size was 5.06 × 6.06 mm (range, 3-8 × 3-18 mm). Fifteen patients (88%) had complete lesion resolution with a mean treatment duration of 3.07 weeks (range, 2-5 weeks) and no adverse events or recurrences with a mean follow up of 9.47 months (range, 6-27 months). Two patients (12%) underwent lesion excision after 6 weeks of timolol failed to yield resolution. CONCLUSION: Topical timolol appears to be a well-tolerated nonsurgical treatment of ocular PG in both children and adults. Clinicians may wish to consider topical timolol to treat PG as opposed to topical steroids, given the inherent risk of steroid response ocular hypertension and the difficulty to measure intraocular pressure in younger children who require general anesthesia for excision.
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Antagonistas Adrenérgicos beta/uso terapêutico , Doenças da Túnica Conjuntiva/tratamento farmacológico , Granuloma Piogênico/tratamento farmacológico , Timolol/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To compare the outcomes of children with orbital cellulitis treated with intravenous (IV) dexamethasone and antibiotics on admission to patients treated with antibiotics alone. METHODS: Prospective comparative interventional study. Forty-three children admitted to a tertiary institution with orbital cellulitis were enrolled. On admission, all patients were started on broad spectrum IV antibiotics and parents were offered IV dexamethasone (0.3 mg/kg/d every 6 hours for 3 days). Patients whose parents refused steroid treatment served as the control group. RESULTS: Twenty-eight (65%) patients received IV steroids and antibiotics on admission while 15 (35%) received IV antibiotics alone. Children who received IV steroids had significantly shorter hospital stays than those who did not receive steroids (3.8 ± 0.2 days vs. 6.7 ± 0.3 days; p < 0.001). This was true both for children who underwent surgery (5/28 with steroids, 3/15 without; 5.0 ± 0.7 days vs. 7.3 ± 1.2 days; p = 0.011) and for those who did not require surgical intervention (23/28 with steroids, 12/15 without; 3.6 ± 0.6 and 6.5 ± 1.0 days; p < 0.001). Side effects of steroid treatment were mild and did not require termination of therapy. During follow up, all study patients had returned to their baseline health without any cases of decreased vision or disease recurrence. CONCLUSIONS: The results of the current study give additional evidence to the relative safety and efficacy of systemic steroid use concurrently with IV antibiotics in children with orbital cellulitis. This is the first study to recommend IV steroids on hospital admission and a standardized dosing regimen. Children who received steroids had a shorter hospital stay than those who did not.
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Antibacterianos/administração & dosagem , Dexametasona/administração & dosagem , Infecções Oculares Bacterianas/tratamento farmacológico , Glucocorticoides/administração & dosagem , Celulite Orbitária/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Humanos , Infusões Intravenosas , Injeções Intravenosas , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos ProspectivosRESUMO
PURPOSE: To identify demographic features and clinical outcomes associated with post-traumatic silent sinus syndrome. METHODS: A retrospective review was carried out at 3 academic medical centers to identify all cases of post-traumatic silent sinus syndrome. Clinical features and management strategies were recorded. Postoperative outcomes were assessed, and statistical analyses were performed via a dedicated computerized software package. RESULTS: Twenty cases were identified (14 men and 6 women, mean age = 44.2 years). Seven patients underwent sinus surgery as the sole means of treatment, and the mean pre- and postoperative enophthalmos measurements were 2.86 and 1.93 mm. Alternatively, 13 patients underwent combined orbital reconstruction and sinus surgery, respectively; the mean pre- and postoperative enophthalmos measurements were 3.42 and 0.39 mm, respectively. The change in enophthalmos was statistically significantly greater in patients who underwent sinus surgery and orbital reconstruction (p = 0.00028). Among patients who underwent sinus surgery alone, one patients (14.2%) experienced complete resolution of enophthalmos, as compared with 10 patients (76.9%) who underwent combined procedures. CONCLUSIONS: This study represents the largest published cohort of patients with post-traumatic silent sinus syndrome. Combined orbital reconstruction and sinus surgery results in greater reductions of enophthalmos and a markedly improved chance of postoperative symmetry of globe position.