Rhino-orbital mucormycosis: Our experiences with clinical  features and management in a tertiary care center

Singh, Satya Prakash; Rana, Jagriti; Singh, Vinod; Singh, Rupanshi; Sachan, Reena; Singh, Shivangi; Jain, Sandeep

doi:10.22336/rjo.2021.69

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…In our reviewed studies, the specific indications for retrobulbar injection of the drug were visual loss, signs of orbital apex involvement, and progression of the disease despite appropriate systemic medical and surgical treatments. 25 , 28 – 31 , 33 , 34 Similar indications were elucidated by Hirabayashi et al 19 In addition, we found that this route of the drug administration should be considered in earlier stages, especially in cases that are not good candidates for extensive surgical interventions (i.e., pediatrics and admitted patients to an intensive care unit, ICU). 29 , 31 In the COVID-19 era, many cases are admitted to the ICU and, therefore, are not candidates with favorable outcomes following surgical interventions (including paranasal sinuses and orbital debridements).…”

Section: Discussionsupporting

confidence: 76%

“…In addition, the injection may reduce the load of orbital disease and thus postpone future surgeries. 25 , 28 – 31 , 33 , 34 The outcomes of retrobulbar injections (except for globe salvage) were a preserved or enhanced ocular state through a reduction in ophthalmic signs including visual impairment, pain, swelling, ptosis, proptosis, and extraocular motility restriction. 25 , 26 , 33 – 35 Occurrence of side effects was rare and, in some, transient.…”

Section: Resultsmentioning

confidence: 99%

“…25 , 28 – 31 , 33 , 34 The outcomes of retrobulbar injections (except for globe salvage) were a preserved or enhanced ocular state through a reduction in ophthalmic signs including visual impairment, pain, swelling, ptosis, proptosis, and extraocular motility restriction. 25 , 26 , 33 – 35 Occurrence of side effects was rare and, in some, transient. These adversities included aggravation of orbital inflammation, visual impairment, swelling, chemosis, ptosis, and extraocular motility restriction (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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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“…Scant literature is available including case reports, small data-based case series, and reviews describing an association between COVID-19 and ROCM [ Table 3 ]. [ 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 ] However, the swiftness and ferocity with which this pandemic has engulfed the world and the unprecedented investment of healthcare professionals and resources has made it necessary to evaluate any level of evidence available in the literature not only to guide management strategy but also to plan current and future research. With varied clinical forms of mucormycosis, pulmonary mucormycosis was the predominant clinical form (87.5%) observed, while ROCM was the most common presentation (28.6%) that was noted in developing countries like India.…”

Section: Rocm and Covid-19 Disease: Perspectives And Changing Trendsmentioning

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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Amphotericin-B-liposomal/antibacterials/immunosuppressants

2022

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Rhino-orbital mucormycosis: Our experiences with clinical features and management in a tertiary care center

Abstract: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cited by 4 publications

References 24 publications

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

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

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

Amphotericin-B-liposomal/antibacterials/immunosuppressants

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