OBJECTIVE: To describe the clinical features, causative agents, management practices, and outcomes of preseptal and orbital cellulitis at a tertiary-care center in a developing country. METHODS: This is a retrospective case series of preseptal and orbital cellulitis seen at the Orbit Clinic of the Philippine General Hospital from January 1990 to December 1995. The medical records were reviewed and the following data obtained: age, gender, manner of disease presentation, causative agent, medical interventions, and outcomes. RESULTS: Fifty-six patients with preseptal cellulitis and 35 with orbital cellulitis were identified. Among the patients with preseptal cellulitis, the mean age at presentation was 12.6 +/- 17.0 years. No gender predilection was observed. The most common presenting signs were lid swelling (all patients), eye redness (34 %), fever (29%), and eye discharge (27 %). Bilateral involvement occurred in 9 patients. Among those with orbital cellulitis, 25 were classified as orbital cellulitis, 5 as orbital abscess, and 5 as cavernous sinus thrombosis. There were slightly more females than males (1.3:1). The mean age at presentation was 17.1 +/- 18.6 years. The most common symptoms were lid swelling (94 %), ophthalmoplegia (89 %), chemosis (77%), proptosis (71%), and decreased vision (51%). Both conditions were associated with antecedent infectious conditions such as skin and lid infection, sinusitis, dental abscess, respiratory-tract infection, and trauma. Staphylococcus was the most common organism isolated. The most common initial antibiotics used were beta-lactamase-resistant penicillins. Other antibiotics were added based on clinical response and microbial studies. Orbital cellulitis was associated with sight threatening complications such as glaucoma, retinal vascular occlusion, exposure keratitis, and optic-nerve compression. CONCLUSIONS: The etiology of preseptal and orbital cellulitis in this series differs from that in developed countries. Preseptal and orbital cellulitis should be distinguished early so that proper management can be instituted. Orbital cellulitis is associated with greater mortality and morbidity. CT scan and microbial studies are invaluable for appropriate diagnosis and management of orbital cellulitis.
Human ; Male ; Female ; Young Adult ; Adolescent ; ORBITAL CELLULITIS ; CASE REPORTS ;

Objective: To detect and characterize retinoblastoma susceptibility gene (RB1) mutations in tumor samples collected from Filipino patients with retinoblastoma. Methods: Six tumor samples were obtained from Filipino patients diagnosed with retinoblastoma. DNA was extracted from the tumor samples and exons 13-21 of the RB1 gene were amplified by polymerase chain reaction (PCR). PCR amplification products were subsequently purified and sequenced. Mutation detection and characterization were done by alignment of obtained sequences to the RB1 reference sequence from NCBI GenBank using Bioedit® software. The identified mutations were correlated with clinical presentation and family history. These mutations were also compared to known mutations reported in the RB1 Gene Mutation Leiden Open Variation Database (LOVD). Results: Mutations were detected in two out of the six samples. In a patient with unilateral disease and no family history, two mutations were identified: a novel CGT>AGT (Arginine → Serine) missense mutation in position c.1861 of exon 19 and a previously reported CGA>TGA (Arginine → STOP) nonsense mutation in position c. 1735 of exon 18. A possible large exonic deletion was identified in a case of unilateral disease with no family history. Conclusion We were able to identify both novel and known mutations in the RB1 gene of Filipino retinoblastoma cases using DNA sequencing techniques. These techniques may be applied to further characterize the genetic mutations of Filipino retinoblastoma cases and their families in developing a rational method of genetic testing for early diagnosis and counseling.
Retinoblastoma ; Genes, Retinoblastoma