Globe Salvage Using CT Guided Orbital apex amphotericin B injection in patients with orbital Mucormycosis and apex involvement
Author: Farzad Pakdel
Base Hospital / Institution: Orbit Clinic, IK hospital complex, Tehran University of Medical Sciences;Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran
Rapid fire oral presentation
Abstract ID: 24-160
Purpose
A high incidence of sinu-orbital Mucormycosis as a fulminant and opportunistic fungal infection happened following the COVID-19 pandemic. However, still there patients suffering from mucormycosis with a variety of underlying conditions. Generally, patients with orbital mucormycosis with apical or extensive involvement are considered hopeless for saving the eye and are candidates for exenteration. In this study we aimed to report the compare outcome of precise CT scan guided orbital amphotericin C delivery to apical region to the method of retobulbar amphotericin B injection in patients with orbital mucormycosis and apical involvement.
Methods
In this pilot study clinical trial from September to January 2021, thirty patients with orbital COVID-19-associated Mucormycosis underwent intra-orbital injection of amphotericin B in two groups of 15 patients; A: CT-guidance injection and B: conventional retrobulbar injection. All patients underwent comprehensive orbital clinical exam and orbital MRI before and after CT guided orbital amphotericin injections before and after injection. Results were evaluated and analyzed three months after injection.
Results
A total of thirty patients with mean age of 52±11.86 were enrolled in this study. Twenty-three (76.7%) patients were male; group A: 11 (73.3%) and B: 12 (80%). The majority of the patients in both group were diabetics (A: 10 (66.7%), B: 10 (76.9%)). There was no history of malignancy, chemotherapy, and immunomodulator therapy. Cardiovascular disease was seen in 9 (32.1%) cases (A: 2 (13.3%), B: 7 (53.8%)). Most patients in both groups had received corticosteroids and antiviral therapy for their recent COVID-19, 23 (82.1%) and 25 (89.3%), respectively. No patient in group A underwent exenteration. Eleven (78.6%) patients in group B underwent orbital exenteration.
Conclusion
Intra-orbital amphotericin injection under CT-guidance may be considered as an effective method in patients with orbital mucormycosis. This method may decrease exenteration without increasing mortality of patients.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Alireza | Abrishami | Orbit Clinic, IK hospital complex, Tehran University of Medical Sciences;Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran |
| Mahsa | Alborzi Avanaki | Orbit Clinic, IK hospital complex, Tehran University of Medical Sciences;Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran |
| Mohammadreza | Salehi | Orbit Clinic, IK hospital complex, Tehran University of Medical Sciences;Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran |
| Sadegh | Khodavaisy | Orbit Clinic, IK hospital complex, Tehran University of Medical Sciences;Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran |
| Fatemeh | Farokh | Orbit Clinic, IK hospital complex, Tehran University of Medical Sciences;Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran |
