Guided Intra-orbital Amphotericin Injection in COVID-19 associated Mucormycosis
Farzad Pakdel1 *, Alireza Abrishami 10 , Mahsa Alborzi Avanaki 10 , Hossein Ghanaati10 , Mohammadreza Salehi10 , Sadegh Khodavaisy10
- Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: This study was presented in ARVO 2022 as oral lecture. A high incidence of sinu-orbital Mucormycosis as a fulminant and opportunistic fungal infection happened following the COVID-19 pandemic. Thus named as CAM. Generally, it has unfavorable prognosis. Traditionally, patients with orbital mucormycosis with apical or extensive involvement are considered hopeless for saving the eye and are candidates for exenteration. Meanwhile management of large number of patients with CAM, increased our surge to search for more effective strategies to decrease mortality and morbidity of this critical disease. We designed and applied CT scan guided orbital amphotericin C delivery. In this study we aimed to report this novel technique and results of this method in control of orbital mucormycosis with 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 can be considered as a highly effective method in patients with orbital mucormycosis. This method may decrease exenteration without increasing mortality of patients.
