kortikosteroid pada selulitis orbita

8/9/2019 kortikosteroid pada selulitis orbita

1/16

Mutiara Dara Ratih

FAA 110 022

Departemen Ilmu Kesehatan Mata RSUD dr. Doris Sylvanus

Palan!araya

Fa!ultas Kedo!teran Universitas Palan!araya

201"


2/16

#a$!roud

• %r&ital $ellulitis 'ith su&periosteala&s$ess in the pediatri$ patient is most(re)uently $aused &y se$ondary e*tension

o( in(e$tion and+or in,ammation (rom theparanasal sinuses.

• -he treatment o( su&periosteal a&s$essesin the pediatri$ ae roup remains$ontroversial. #roadspe$trum intravenousanti&ioti$s are re)uired in all patients.


3/16

• -here/re in$reased levels o( a variety o(in,ammatory $yto!ines in the sinonasalmu$osa o( patients 'ith sinusitis.

•

-reatment 'ith intravenous $orti$osteroids has&een sho'n to de$rease levels o( some o(these in,ammatory $yto!ines and there(ore(a$ilitate the treatment o( a$ute and $hroni$sinusitis.

• Intravenous steroids have also &een sho'n tode$rease mu$osal edema potentially helpin'ith sinus drainae.


4/16

• Althouh &roadspe$trum anti&ioti$s are al'aysused in the initial manaement o( thesu&periosteal a&s$ess the use o($orti$osteroids to treat the or&ital su&periosteala&s$ess has not &een 'ell investiated.

• #e$ause intravenous $orti$osteroids are o(tenused in the manaement o( a$ute sinusitis attheir institution they postulated that$orti$osteroids may also have a &ene$ial rolein the manaement o( pediatri$ su&periosteala&s$esses.


5/16

Purpose and Method

• Purpose: -o determine the ee$t o( intravenous$orti$osteroids in the a$ute manaement o(pediatri$ or&ital $ellulitis 'ith su&periosteala&s$ess.

• Methods: -he inpatient re$ords o( all patientstreated (or or&ital $ellulitis 'ith su&periostealor&ital a&s$ess &et'een 3anuary 2001 and Auust2004 'ere revie'ed. -he use o( $orti$osteroids

lenth o( hospital stay need (or suri$al drainaetreatment $ourse and $lini$al out$omes 'ererevie'ed. A t test and Fisher e*a$t test analysis'ere $al$ulated to evaluate statisti$al sini$an$e.


6/16

• A total o( 25 patients 'ere identiedranin in ae (rom 11 to 1" years.

• %ne patient 'as e*$luded &e$ause the

$orti$osteroids 'ere not iven in thea$ute treatment o( the or&ital $ellulitis.

• -'elve patients re$eived intravenous

$orti$osteroids and 11 patients did notre$eive $orti$osteroids durin theirhospitali6ations.


7/16

Result


8/16


9/16

Dis$ussion

• -he most (re)uent $ause o( pediatri$ or&italsu&periosteal a&s$esses is a$ute sinusitis espe$iallythat involvin the ethmoid and ma*illary sinuses.

• -here is $urrently no denitive standard (or the

treatment o( su&periosteal a&s$esses in thepediatri$ ae roup

• Some arue7

– initial trial o( intravenous anti&ioti$s is 'arranted

– reservin suri$al treatment (or patients 'ho do notrespond to anti&ioti$ therapy

– immediate suri$al drainae o( the a&s$ess and in(e$tedsinuses is re)uired


10/16

• 8levated levels o( variousproin,ammatory $yto!ines have&een (ound in the sinonasal mu$osa

o( patients 'ith sinusitis and a(tertreatment 'ith $orti$osteroidsmu$osal &iopsy spe$imens have

demonstrated redu$tion in the levelso( some o( these $yto!ines.


11/16

• 9orti$osteroid use a(ter endos$opi$sinus surery in $hildren has also&een sho'n to result in less mu$osal

edema s$arrin septae (ormationand lo'er in$iden$e o( $losure o( thema*illary ostium.


12/16

• the presen$e and si6e o( the a&s$ess does notne$essarily $orrelate dire$tly 'ith the severityo( the or&ital in(e$tion. It/s due in part to an

e*u&erant in,ammatory response to theunderlyin sinusitis that has spilled over intothe su&periosteal spa$e.

• 9ontrollin and suppressin this e*u&erant

in,ammatory response may &e a potential&enet (rom intravenous $orti$osteroids usedin $on:un$tion 'ith &roadspe$trumanti&ioti$s.


13/16

• In their study initial treatment 'ith $orti$osteroids$learly did not adversely ae$t $lini$al out$omes. ;opatients had adverse rea$tions to the use o( intravenous$orti$osteroids and all patients had resolution o( the

su&periosteal a&s$esses a(ter treatment.• -he dieren$e in lenth o( hospitali6ation and need (or

surery 'as not sini$antly dierent &et'een thepatients treated 'ith $orti$osteroids and those treated'ithout $orti$osteroids.

• A statisti$ally sini$ant smaller num&er o( patientsre)uired intravenous anti&ioti$ use a(ter dis$hare 'hentreated 'ith $orti$osteroids.


14/16


15/16

• Althouh there are many theoreti$al advantaes (or thead:un$t use o( intravenous $orti$osteroidstheir revie' 'asnot ade)uate in determinin a true lin! &et'een$orti$osteroids and improvement.

• a(ter dis$hare 'hen treated 'ith intravenous$orti$osteroids 'e $annot determine throuh our revie''hi$h $lini$al parameters 'ere used in de$idin 'hether ornot intravenous anti&ioti$s 'ere needed.

• all patients revie'ed had dierent $onsultants and sureons'ith dierent $riteria (or surery and anti&ioti$ treatment.

• 'as no standard dosae (or the $orti$osteroids iven 'iththe patients revie'ed in this study re$eivin intravenousde*amethasone ranin (rom 0.44 to 1 m+! (rom a sinledose to every 12 hours (or = days.


16/16

Summary

• the use o( intravenous $orti$osteroidsdoes not appear to adversely ae$t$lini$al out$omes and may &e &ene$ial

in the treatment o( pediatri$ or&ital$ellulitis 'ith su&periosteal a&s$ess.

• patients treated 'ith intravenous

$orti$osteroids 'ere mu$h less li!ely tore)uire intravenous anti&ioti$treatment at dis$hare.

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kortikosteroid pada selulitis orbita