Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

摘要 引言：眼眶蜂窝织炎的标准管理方案为静脉输注广谱抗生素联合相关鼻窦炎的治疗。
研究目的：本研究旨在评估联用糖皮质激素是否能够更早缓解炎症并改善疾病转归。
研究方法：我们独立检索了PubMed、SCOPUS、Embase、Web of Science及Cochrane数据库，检索时限截至2019年12月。对纳入的研究，我们通过住院时长、手术引流发生率、眶周水肿、视力、C反应蛋白（C-reactive protein）水平及血清白细胞（WBC）计数，对比糖皮质激素联合抗生素治疗组与单纯抗生素治疗组，聚焦评估眼眶蜂窝织炎及疾病发病相关指标。
研究结果：与单纯抗生素治疗组相比，糖皮质激素联合抗生素治疗组的眼眶蜂窝织炎确诊患者入院后住院时长显著缩短（标准化均数差SMD = −4.02 [−7.93; −0.12]，P=0.04，I²=96.9%）。糖皮质激素联合抗生素治疗组的手术引流发生率更低（优势比OR=0.78 [0.27; 2.23]，P=0.64，I²=0.0%）。
研究结论：在眼眶蜂窝织炎的全身抗生素治疗基础上附加全身糖皮质激素治疗，可减轻眼眶炎症，且感染加重风险较低。基于本分析，我们认为短期早期使用糖皮质激素有助于缩短住院时长并延缓炎症进展。