Targeted orbital intervention in the management of sino-orbital mucormycosis cases.
Humans
Mucormycosis
/ diagnosis
Male
Eye Infections, Fungal
/ microbiology
Prospective Studies
Female
Orbital Diseases
/ microbiology
Adult
Middle Aged
Antifungal Agents
/ therapeutic use
Amphotericin B
/ therapeutic use
COVID-19
/ epidemiology
SARS-CoV-2
Follow-Up Studies
Young Adult
Visual Acuity
Debridement
/ methods
Aged
Adolescent
Treatment Outcome
Orbit
Journal
Indian journal of ophthalmology
ISSN: 1998-3689
Titre abrégé: Indian J Ophthalmol
Pays: India
ID NLM: 0405376
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
03
01
2024
accepted:
11
05
2024
medline:
27
9
2024
pubmed:
27
9
2024
entrez:
27
9
2024
Statut:
ppublish
Résumé
Many countries from South-East Asia reported an epidemic of sino-orbital mucormycosis (SOM), otherwise a rare disease, during the coronavirus disease 2019 pandemic. SOM, a potentially fatal disease, is typically treated with orbital exenteration and systemic antifungals after metabolic stabilization. There is no clear evidence of survival benefit of exenteration in the literature, and thus, there have been attempts at globe conserving treatments like orbital infusion after limited debridement and intraorbital injections with Amphotericin B (IOAB). We conducted a prospective comparative interventional study at a tertiary eye care hospital to evaluate treatment outcomes with the use of adjunctive IOAB in cases of SOM with mild to moderate orbital disease. Thirty-six patients of SOM with mild to moderate orbital disease were recruited in the study. In the intervention group, 23/26 (885%) eyes had stable orbital disease at the end of treatment (4-6 weeks). No deterioration in visual acuity was noted as a result of treatment. In 8/26 (30.77%) patients, inflammation was noted as a side effect of IOAB requiring temporary discontinuation of injections. The mean follow-up for cases was 14.2 months (range 12-15 months). 1/23 (4.35%) patients had relapse of orbital disease at 3 months. Twenty-one patients are alive on last follow-up. Of the patients who refused treatment (controls), 2/9 (22.22%) patients relapsed. One of these patients with relapse underwent exenteration, while the other was managed with IOAB. At a follow-up of 14 months (range 12-15 months), eight patients are alive. On evaluating the ocular parameters in salvaged eyes, improvement in extraocular movements was noted in 75-80% cases. The degree of proptosis and resistance to retropulsion did not change significantly. In the current study, an improvement in the globe salvage rates was noted in cases of SOM with mild to moderate orbital disease treated with adjunctive IOAB as compared to controls at a mean follow-up of 14 months, although it did not achieve statistical significance. The study supports the inclusion of IOAB in routine management of mild to moderate orbital disease.
Identifiants
pubmed: 39331440
doi: 10.4103/IJO.IJO_18_24
pii: 02223307-202472100-00020
doi:
Substances chimiques
Antifungal Agents
0
Amphotericin B
7XU7A7DROE
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1488-1494Informations de copyright
Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.
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