Skripsi

Keterlibatan Orbita pada Rinosinusitis Akut di Rumah Sakit Cipto Mangunkusumo = Orbital Involvement of Acute Rhinosinusitis at Dr. Cipto Mangunkusumo Hospital.

Latar Belakang Rinosinusitis seringkali menimbulkan komplikasi pada rongga orbita karena letaknya yang berdekatan serta faktor anatomi lainnya. Keterlibatan orbita menyebabkan berbagai gejala, mulai dari nyeri hingga kebutaan. Populasi Indonesia berisiko tinggi karena maraknya infeksi fungi invasif dan tingginya prevalensi diabetes melitus. Sebelumnya, belum terdapat penelitian prevalensi keterlibatan orbita pada rinosinusitis akut di Indonesia. Penelitian ini bertujuan untuk mengetahui prevalensi, jenis komplikasi, dan faktor risiko keterlibatan orbita pada rinosinusitis akut di RSCM pada tahun 2023-2024. Metode Studi cross sectional ini menggunakan data retrospektif rekam medis pasien rinosinusitis akut di RSCM pada tahun 2023-2024. Data dianalisis secara deskriptif analitik. Analisis bivariat dilakukan menggunakan Chi Square atau Fisher’s Exact Test, sedangkan analisis multivariat menggunakan Firth Logistic Regression pada tingkat signifikansi 0,05. Hasil Terdapat 144 subjek penelitian dengan rinosinusitis akut. Ditemukan keterlibatan orbita pada 13 kasus (9%). Jenis keterlibatan orbita terbanyak berupa orbital apex syndrome (30,8%), diikuti Edema Inflamatori (23,1%), dan Selulitis Orbita (23,1%). Sinus etmoid terlibat pada seluruh kasus. Gejala dominan berupa edema palpebra (84,6%) dan penurunan penglihatan (76,9%) dengan median logMAR visus 2,48. Mayoritas pasien (69,2%) datang dalam durasi >7 hari. Secara bivariat, faktor risiko signifikan meliputi laki-laki (p < 0,001), etiologi bakteri/jamur (p < 0,001), diabetes melitus (p=0,004), dan bony dehiscence (p < 0,001), tetapi hanya laki-laki dan etiologi jamur yang signifikan secara independen. Kesimpulan Prevalensi keterlibatan orbita pada rinosinusitis akut sejumlah 9% dengan jenis keterlibatan utama berupa orbital apex syndrome (30,8%). Faktor jenis kelamin laki-laki, etiologi bakteri/jamur, diabetes melitus, dan bony dehiscence memiliki hubungan yang signifikan dengan keterlibatan orbita.
Kata Kunci: bony dehiscence, diabetes, infeksi jamur invasif, orbita, orbital apex syndrome, rinosinusitis akut


Introduction Rhinosinusitis is frequently associated with orbital complications due to anatomical proximity and predisposing anatomical factors. Orbital involvement produces symptoms ranging from pain to blindness. Indonesians are at higher risk because of the burden of invasive fungal infections and high diabetes prevalence. However, no study has reported the prevalence of orbital involvement in acute rhinosinusitis in Indonesia. This study aimed to assess the prevalence, types, and risk factors of orbital involvement in acute rhinosinusitis at RSCM in 2023-2024. Method This cross-sectional study analyzed retrospective medical records of acute rhinosinusitis patients at RSCM during 2023-2024 using descriptive (Chi-square or Fisher’s exact test), and multivariate (Firth logistic regression) analyses with a significance level of 0.05. Results A total of 144 patients were included. Orbital involvement was observed in 13 cases (9%). The most common presentation was orbital apex syndrome (30.8%), followed by Inflammatory Edema (23.1%), and Orbital Cellulitis (23.1%). The ethmoidal sinus was involved in all cases. The main symptoms were palpebral edema (84.6%) and decreased vision (76.9%), with a median logMAR acuity of 2.48. Most patients (69.2%) presented after 7 days. Significant risk factors in bivariate analysis were male sex (p < 0.001), bacterial/fungal etiology (p < 0.001), diabetes mellitus (p=0.004), and bony dehiscence (p < 0.001). Only male sex and etiology remain independently significant. Conclusion The prevalence of orbital involvement in acute rhinosinusitis was 9%, with orbital apex syndrome (30.8%) as the most common manifestation. Male sex, bacterial/fungal etiology, diabetes, and bony dehiscence were significantly associated with orbital involvement.
Keywords: acute rhinosinusitis, orbital apex syndrome, orbit, invasive fungal infection, diabetes, bony dehiscence