Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis

Murthy, Ramesh; Bagchi, Aadhyaa; Gote, Yogita S; Desai, Sanjay

doi:10.4103/ijo.ijo_1511_21

Cited by 6 publications

(4 citation statements)

References 14 publications

(21 reference statements)

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“…Murthy et al . [ 59 ] described an alternative technique of retrobulbar injections using an intravenous cannula to stop the orbital disease progression in ROCM. Retrobulbar injection of AMB is an off-label procedure and has an associated risk of significant complications.…”

Section: Treatmentmentioning

confidence: 99%

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

Karkhur

Soni

Chauhan

et al. 2022

Indian Journal of Ophthalmology

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This study aimed to review the current literature for epidemiology, pathogenesis, clinical spectrum and management of rhino-orbito-cerebral-mucormycosis (ROCM), especially highlighting the association between ROCM and COVID-19 disease and factors resulting in its resurgence during the pandemic. Mucormycosis is a rare, but an important emerging opportunistic fungal infection, often associated with high morbidity and mortality. ROCM is the commonest and also the most aggressive clinical form occurring in debilitated patients in conjunction with sinus or para-sinus involvement due to the propensity for contiguous spread. Recently ROCM has shown an unprecedented resurgence during the current pandemic. Reports from different parts of the world indicated an increased risk and incidence of ROCM in patients who had required hospital admission and have recovered from moderate-to-severe COVID-19 disease. A majority of mucormycosis cases have been reported from India. The presence of diabetes mellitus (DM) and use of corticosteroids for COVID-19 pneumonia were found to be the key risk factors, resulting in higher mortality. Amidst the ongoing pandemic, with the third wave already having affected most of the world, it becomes imperative to adopt a risk-based approach toward COVID-19 patients predisposed to developing ROCM. This could be based on the most recently published literature and emerging data from centers across the world. The present review intended to elucidate the causes that brought about the current spike in ROCM and the importance of its early detection and management to reduce mortality, loss of eye, and the need for mutilating debridement.

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Section: Treatmentmentioning

confidence: 99%

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

Karkhur

Soni

Chauhan

et al. 2022

Indian Journal of Ophthalmology

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“…In 1 study, the drug was delivered in the orbital cavity for 5 days by insertion of an intravenous cannula. 32 In another study, combined intravitreal and retrobulbar injections were done in patients with endophthalmitis. 27 Although the outcomes of protocols for retrobulbar injections among the reviewed studies cannot be compared with each other by statistical analysis due to inadequate data, but these studies revealed that the effectiveness of the injections in reducing signs of orbital disease is higher among cases with minimal orbital involvement, and that advanced cases needed more injections exhibiting poorer responses to the injections.…”

Section: Resultsmentioning

confidence: 99%

Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review

Sharifi

Akbari

Shafie’ei

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM). Methods: The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants. Results: A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases. Conclusions: Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.

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“…However, due to its high potential to induce nephrotoxicity, continuous monitoring of the patients is necessary. Also, combination therapy with echinocandins and amphotericin B is accepted as second-line therapy (21). Other medications such as Isavuconazole or Posaconazole have been used in cases with invasive mucormycosis (22).…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 rhinocerebral mucormycosis, a life-threatening event in the background of immunosuppressive condition: A case report

Tajik

Chegini

2023

Preprint

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Introduction: In patients suffering from COVID-19, immunocompromised conditions or immunosuppressive medications such as corticosteroids may predispose them to early or delayed invasive fungal infections that invade cerebral components. This study, for the first time, describes a case of COVID-19 disease diagnosed with rhinocerebral mucormycosis through cerebrospinal fluid (CSF) analysis. Case presentation: A 32-year-old woman with a history of referral and hospitalization due to COVID-19 about a month ago was being treated with immunosuppressive drugs, manifested by lower extremity plegia. In the imaging assessment, intracranial hemorrhage (thalamus zone) and mass like lesion were revealed. In cytological assessment, acute inflammations associated with fungal infection in accordance with the diagnosis of mucormycosis were definitively confirmed. Despite antifungal medication, consciousness declined one week later, and the patient developed thromboembolism and died. Conclusion In patients with a COVID-19 background of immunosuppressive therapy or clinical situations related to immunosuppression such as uncontrolled diabetes, rhinocerebral mucormycosis will always be an ambush. Therefore, screening and prevention measures should be considered.

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Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis

Cited by 6 publications

References 14 publications

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

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

Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review

Post-COVID-19 rhinocerebral mucormycosis, a life-threatening event in the background of immunosuppressive condition: A case report

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