Abstract：
BACKGROUND: Orbital involvement of invasive fungal sinusitis (IFS) is an ominous prognostic marker that should prompt rapid intervention. Transcutaneous retrobulbar administration of amphotericin B (TRAMB) is an off-label adjunctive treatment that can increase drug penetrance into diseased orbital tissue. To date, there is a lack of consensus regarding the use of TRAMB for treatment of IFS with orbital involvement.
OBJECTIVE: This systematic review aims to synthesize the indications, efficacy, and potential complications of TRAMB.
METHODS: PubMed, EMBASE, and Web of Science databases were probed for systematic review. Article search was conducted through June 2023 using the keywords \"invasive fungal sinusitis,\" \"invasive fungal rhinosinusitis,\" \"rhino-orbital mucormycosis,\" \"rhinosinusitis,\" \"orbital,\" \"retrobulbar,\" and \"amphotericin.\"
RESULTS: In suitable cases as determined by radiologic and clinical evaluation, TRAMB administration has the potential to improve orbital salvage rates and improve versus stabilize visual acuity. Treatment complications are more likely with deoxycholate than with liposomal amphotericin formulations. The existing literature describing use of TRAMB is limited due to its retrospective nature, but the increase in IFS cases since 2020 due to the COVID pandemic has broadened the literature.
CONCLUSIONS: TRAMB is an effective adjunctive treatment in IFS with mild-to-moderate orbital involvement when used in combination with standard of care debridement, systemic antifungal therapy, and immunosuppression reversal. Prospective longitudinal studies and multi-institutional randomized trials are necessary to determine the definitive utility of TRAMB.
OBJECTIVE: This systematic review aims to synthesize the indications, efficacy, and potential complications of TRAMB.
METHODS: PubMed, EMBASE, and Web of Science databases were probed for systematic review. Article search was conducted through June 2023 using the keywords \"invasive fungal sinusitis,\" \"invasive fungal rhinosinusitis,\" \"rhino-orbital mucormycosis,\" \"rhinosinusitis,\" \"orbital,\" \"retrobulbar,\" and \"amphotericin.\"
RESULTS: In suitable cases as determined by radiologic and clinical evaluation, TRAMB administration has the potential to improve orbital salvage rates and improve versus stabilize visual acuity. Treatment complications are more likely with deoxycholate than with liposomal amphotericin formulations. The existing literature describing use of TRAMB is limited due to its retrospective nature, but the increase in IFS cases since 2020 due to the COVID pandemic has broadened the literature.
CONCLUSIONS: TRAMB is an effective adjunctive treatment in IFS with mild-to-moderate orbital involvement when used in combination with standard of care debridement, systemic antifungal therapy, and immunosuppression reversal. Prospective longitudinal studies and multi-institutional randomized trials are necessary to determine the definitive utility of TRAMB.
摘要：
背景：侵袭性真菌性鼻窦炎（IFS）的眼眶受累是一个不祥的预后指标，应迅速进行干预。两性霉素B（TRAMB）的经皮球后给药是一种标签外辅助治疗，可以增加药物对患病眼眶组织的渗透。迄今为止,对于使用TRAMB治疗有眼眶受累的IFS缺乏共识.
目的：本系统综述旨在综合适应症，功效,和TRAMB的潜在并发症。
方法：PubMed，EMBASE,和WebofScience数据库进行了系统评价。文章搜索一直持续到2023年6月，使用关键词“侵袭性真菌性鼻窦炎，侵袭性真菌性鼻窦炎,\"\"犀牛眶毛霉菌病,“鼻窦炎”,\"\"轨道,\"\"后球杆，\"和\"两性霉素。\"
结果：在通过放射学和临床评估确定的合适病例中，TRAMB给药具有改善眼眶抢救率和改善与稳定视敏度的潜力。与脂质体两性霉素制剂相比，脱氧胆酸盐更可能出现治疗并发症。描述TRAMB使用的现有文献由于其回顾性性质而受到限制，但自2020年以来，由于COVID大流行，IFS病例的增加扩大了文献。
结论：TRAMB是IFS轻至中度眼眶受累的一种有效的辅助治疗方法，与标准治疗清创结合使用时，全身抗真菌治疗,和免疫抑制逆转。前瞻性纵向研究和多机构随机试验是必要的，以确定TRAMB的最终效用。
目的：本系统综述旨在综合适应症，功效,和TRAMB的潜在并发症。
方法：PubMed，EMBASE,和WebofScience数据库进行了系统评价。文章搜索一直持续到2023年6月，使用关键词“侵袭性真菌性鼻窦炎，侵袭性真菌性鼻窦炎,\"\"犀牛眶毛霉菌病,“鼻窦炎”,\"\"轨道,\"\"后球杆，\"和\"两性霉素。\"
结果：在通过放射学和临床评估确定的合适病例中，TRAMB给药具有改善眼眶抢救率和改善与稳定视敏度的潜力。与脂质体两性霉素制剂相比，脱氧胆酸盐更可能出现治疗并发症。描述TRAMB使用的现有文献由于其回顾性性质而受到限制，但自2020年以来，由于COVID大流行，IFS病例的增加扩大了文献。
结论：TRAMB是IFS轻至中度眼眶受累的一种有效的辅助治疗方法，与标准治疗清创结合使用时，全身抗真菌治疗,和免疫抑制逆转。前瞻性纵向研究和多机构随机试验是必要的，以确定TRAMB的最终效用。
