Clinical Outcomes in Children With Orbital Cellulitis and Radiographic Globe Tenting. Issue 4 (July 2018)

• Record Type: Journal Article
• Authors: Lindsay, Rebecca A.; Weiss, Avery H.; Kelly, John P.; Anderson, Valerie C.; Lindsay, Theodore H.; Cabrera, Michelle T.
• Is Part Of: Ophthalmic plastic and reconstructive surgery. Volume 34:Issue 4(2018)
• Publication Date: 2018-07
• Subjects: Eye -- Surgery -- Periodicals; Ophthalmic plastic surgery -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Ophthalmologic Surgical Procedures -- Periodicals; Ophthalmology -- Periodicals; Surgery -- Periodicals; 617.70592
• DOI: 10.1097/IOP.0000000000000976
• Languages: English
• ISSNs: 0740-9303

Abstract

Abstract : Purpose: Axial displacement of the globe with tenting centered on the optic nerve-globe junction is a predictor of visual loss in adults. The purpose of this study was to determine the visual outcomes of children with orbital cellulitis and globe tenting. Methods: The records of 46 consecutive children with orbital cellulitis at a single tertiary children's hospital were reviewed retrospectively. Initial and final visual acuities were available for 34 of 46 patients (74%). Globe tenting was defined by an angle of 130° or less at the optic nerve-globe junction as derived from sagittal CT or MRI. Visual acuities of 4 children with globe tenting (mean age, 10.3 ± 3.3 years) were compared with those of 30 children without globe tenting (mean age, 10.8 ± 3.5 years). Final logarithm of the minimum angle of resolution visual acuities were analyzed. Results: The mean posterior globe angle was 124.5° ± 8.0° in patients with globe tenting, compared with 145.6° ± 7.4° in the affected eye of the patients without globe tenting ( p = 0.002). Final visual acuity was logarithm of the minimum angle of resolution = 0 following treatment in patients with globe tenting and logarithm of the minimum angle of resolution = 0.02 in patients without tenting ( p = 0.70). Discussion: We propose that the increased elastic compliance of the optic nerve sheath and sclera in children may contribute to better visual outcomes. Conclusions: Pediatric orbital cellulitis with globe tenting may not lead to devastating vision loss as previously seen in adults. Abstract : Globe tenting occurred in 4 of 34 children (12%) with orbital cellulitis. Unlike adults where outcomes are variable, visual acuity outcomes were uniformly excellent (20/20). Increased scleral and optic nerve compliance in children may play a role.