Periocular necrotising fasciitis: a multicentre case series.

Autor:	Rajak SN; Adnexal, Moorfields Eye Hospital, London, UK.; International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia., Figueira EC; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia., Haridas AS; Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia., Satchi K; Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia., Uddin JM; Adnexal, Moorfields Eye Hospital, London, UK., McNab AA; Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia., Rene C; Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK., Sullivan TJ; Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia., Rose GE; Adnexal, Moorfields Eye Hospital, London, UK., Selva D; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
Jazyk:	angličtina
Zdroj:	The British journal of ophthalmology [Br J Ophthalmol] 2016 Nov; Vol. 100 (11), pp. 1517-1520. Date of Electronic Publication: 2016 Feb 02.
DOI:	10.1136/bjophthalmol-2015-307445
Abstrakt:	Introduction: Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone. Results: Twenty-nine patients (20 men; 69%) with PONF were identified and followed up for between 2 months and 10 years (median 57, mean 52.6 months) between 1990 and 2013. Conditions associated with chronic immunocompromise were present in 16/29 (55%). Twenty-one (75%) recalled minor periocular trauma or an infected lesion, two having been assaulted by the same assailant. Systemic shock occurred in 6/29 (21%) patients and 1 died. Group A, β-haemolytic Streptococcus was the most common bacterium identified (25/29, 86%). Intravenous antibiotics were used in all patients, and up to five tissue debridements were required to control the disease in 23/29 (74%); reconstructive surgery was required in 12/29 (41%) patients. One patient died from the disease and visual loss occurred in four eyes of four patients (14%). Conclusions: PONF has a better prognosis than disease elsewhere in the body, but is still associated with significant risk of visual loss and a small risk of death. Intravenous antibiotic treatment with cautious observation may be reasonable in selected patients with a low threshold for debridement. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
Databáze:	MEDLINE
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