Localized surgical debridement for the management of orbital mucormycosis

Abstract

Purpose: To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration. Methods: The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months. Results: The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication. Conclusion: Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient.

Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

“…Murthy et al . [ 63 ] in a series of ten cases with ROCM showed that superior outcomes with localized surgical orbital debridement and application of amphotericin B gel to the site of debridement can help in salvaging the vision and avoiding exenteration in most cases. However, AMB has the potential to incite inflammation and could result in transient orbital soft-tissue edema when locally injected.…”

Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement

“…The orbital involvement was considered stage 3; in the early Stage 3, local debridements were considered the preferred surgical intervention, and exenteration is been suggested for advanced stage 3 disease with extensive orbital involvement. Previously explored globe-sparing treatment options for these patients are local surgical debridement[ 10 ] and TRAMB. [ 4 11 12 ] Additionally, we explored the peri-bulbar route to deliver site-centered amphotericin, and for selecting suitable patients, we categorized them based on their clinical and radiological extent of disease.…”

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

“…In addition, studies including patients with invasive fungal infections in general, and not mucormycosis specifically, and studies including mucormycosis cases not associated with COVID-19 and not separately with CAM cases were excluded. Sixteen studies were excluded due to unavailable–insufficient information [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Four studies were excluded as they included patients with non-microbiologically confirmed SARS-CoV-2 infection [ 25 , 26 , 27 , 28 ].…”