Retrobulbar Amphotericin Injection in Mucormycosis: An Imaging-Based Algorithm for Case Selection
Author: Akshay Nair
Base Hospital / Institution: Dr Agarwal’s Group of Eye Hospitals
ePoster presentation
Abstract ID: 24-172
Purpose
Treating orbital component of Rhino-Orbital-Cerebral Mucormycosis (ROCM) has traditionally been a challenge. Intervention strategies include orbital exenteration, conservative orbital debridement with or without irrigation with amphotericin B and recently, transcutaneous retrobulbar injection of amphotericin B (TRAMB). Currently, there is a lack of clarity regarding the indications and outcomes of TRAMB as a treatment modality.
Methods
Following the wave of COVID-19, the authors cumulatively treated over 200 cases of COVID-19 associated Mucormycosis. Based on the radiological features as seen on MRI of the orbit, the authors have proposed a new treatment schema.
Results
The factors taken into consideration to decide the line of treatment were: involvement of extraocular muscles, presence of contrast enhancement, globe distortion, perineural enhancement and orbital apical involvement. The authors present a detailed, objective treatment algorithm to decide the ideal mode of intervention based on radiological features. The indications for TRAMB were: extraconal fat stranding with diffuse enhancement, orbital apical disease with contrast enhancement, perineural enhancement without intraconal disease. Out of 39 patients treated with TRAMB, 31 orbits (79.55) were salvaged and could avoid orbital exenteration. 5 patients died due to systemic issues and 3 patients required orbital exenteration due to worsening of disease.
Conclusion
The initial outcomes based on the proposed treatment algorithm may help in case selection for transcutaneousretrobulbar injection of Amphotericin B; which has shown promising results. The proposed treatment protocol aims to familiarize clinicians with objective parameters for patient selection for TRAMB, namely the extent of the disease, the clinical features, and radiological findings; viz. the clinical interpretation of areas of contrast uptake and those of necrosis. TRAMB can be considered as a viable option in select cases of orbital mucormycosis where exenteration or debridement are not indicated, or when there is limited orbital disease.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Tarjani | Dave | Dr Agarwal’s Group of Eye Hospitals |
