Predicting severity of periorbital necrotizing fasciitis
Michael I Rothschild1, Richard R Pacheco2, Edward J Wladis1
1Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Albany, New York, USA.
Purpose:
To determine whether severity of periorbital necrotizing fasciitis can be predicted based on premorbid patient characteristics.
Methods:
Records of 10 consecutive patients with periorbital necrotizing fasciitis presenting at a single center, treated by one attending ophthalmic plastic surgeon, were retrospectively reviewed. Demographic information and medical history were used to determine a Charlson Comorbidity Index (CCI) score for each patient. Other variables included presenting visual acuity, number of surgical debridements performed, infectious organism (if known), and visual acuity at last follow-up. Data were compared with Mann-Whitney U test to determine correlation between variables, using p-values as outcome measures.
Results:
Increased age at presentation correlated with worse presenting and final visual acuity, requiring more surgical debridements to control disease (each p < .0001). Worse initial visual acuity correlated with need for increased number of debridements (p = .002), but increased number of debridements did not correlate with final visual acuity (p = .101). CCI did not correlate with initial vision (p = .30), final vision (p = .72), or number of surgical debridements necessary (p = .99). Presenting visual acuity did not correlate with final visual acuity (p = .268).
Conclusion:
Older patients have more severe cases of periorbital necrotizing fasciitis, as defined by increased number of surgeries required to control disease and worse visual outcomes. CCI did not correlate with severity of disease.
