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Abstract：
OBJECTIVE: The purpose of this study was to determine the role of transcutaneous retrobulbar amphotericin B (TRAMB) injection in COVID-19-related rhino-orbital-cerebral mucormycosis (ROCM).
METHODS: This prospective interventional case series included 7 eyes of 7 patients diagnosed with COVID-19 ROCM presenting from May to September 2021 at a tertiary care center in North India. Active or recovered cases of COVID-19 with clinical features suggestive of ROCM and early orbital involvement were included. Following functional endoscopic sinus surgery, patients were given TRAMB 3.5 mg/ml in single ocular quadrant depending upon the muscle involved on contrast-enhanced magnetic resonance imaging (MRI). Patients were followed up for a period of 12 weeks.
RESULTS: All patients were diabetic and COVID-19 reverse transcription-polymerase chain reaction positive. The mean age of patients was 48.4 years ± 11 years, out of which 5 patients were male and 2 were female. The left eye was involved in 57.14% of cases whereas 42.85% of cases had right eye involvement. Presenting complaints were drooping of the upper lid (57.14%; n = 4), proptosis (28.57%; n = 2), facial pain and swelling (85.71%; n = 6), and nasal block (57.14%; n = 4). Stagewise distribution was 3a in four patients (57.14%), 3b in two patients (28.57%), and 4a in one patient. TRAMB injections (median - 3) were given, and improvement was seen in all patients in terms of ocular movements, ptosis, proptosis, and muscle enhancement on MRI scan. Three patients had an increase in intraocular pressure and inflammation which settled within a week with favorable anatomical and functional outcomes.
CONCLUSIONS: Transcutaneous retrobulbar amphotericin B should be considered an adjunctive treatment modality for ROCM patients with limited orbital disease to preserve ocular function.
METHODS: This prospective interventional case series included 7 eyes of 7 patients diagnosed with COVID-19 ROCM presenting from May to September 2021 at a tertiary care center in North India. Active or recovered cases of COVID-19 with clinical features suggestive of ROCM and early orbital involvement were included. Following functional endoscopic sinus surgery, patients were given TRAMB 3.5 mg/ml in single ocular quadrant depending upon the muscle involved on contrast-enhanced magnetic resonance imaging (MRI). Patients were followed up for a period of 12 weeks.
RESULTS: All patients were diabetic and COVID-19 reverse transcription-polymerase chain reaction positive. The mean age of patients was 48.4 years ± 11 years, out of which 5 patients were male and 2 were female. The left eye was involved in 57.14% of cases whereas 42.85% of cases had right eye involvement. Presenting complaints were drooping of the upper lid (57.14%; n = 4), proptosis (28.57%; n = 2), facial pain and swelling (85.71%; n = 6), and nasal block (57.14%; n = 4). Stagewise distribution was 3a in four patients (57.14%), 3b in two patients (28.57%), and 4a in one patient. TRAMB injections (median - 3) were given, and improvement was seen in all patients in terms of ocular movements, ptosis, proptosis, and muscle enhancement on MRI scan. Three patients had an increase in intraocular pressure and inflammation which settled within a week with favorable anatomical and functional outcomes.
CONCLUSIONS: Transcutaneous retrobulbar amphotericin B should be considered an adjunctive treatment modality for ROCM patients with limited orbital disease to preserve ocular function.
摘要：
目的：本研究的目的是确定经皮球后两性霉素B（TRAMB）在COVID-19相关的鼻-眶-脑毛霉菌病（ROCM）中的作用。
方法：本前瞻性介入病例系列包括2021年5月至9月在印度北部三级护理中心就诊的7例确诊为COVID-19ROCM患者的7只眼睛。包括临床特征提示ROCM和早期眼眶受累的积极或康复的COVID-19病例。功能性内窥镜鼻窦手术后，根据对比增强磁共振成像(MRI)所涉及的肌肉,患者在单个眼部象限给予TRAMB3.5mg/ml.对患者进行为期12周的随访。
结果：所有患者均为糖尿病和COVID-19逆转录聚合酶链反应阳性。患者平均年龄为48.4岁±11岁,其中男性5例，女性2例。57.14%的病例累及左眼，42.85%的病例累及右眼。提出的投诉是上眼睑下垂（57.14％；n=4），峰值（28.57%；n=2），面部疼痛和肿胀（85.71％；n=6），鼻塞（57.14%；n=4）。4例患者的分期分布为3a(57.14%)，两名患者（28.57％），和4a在一个病人。给予TRAMB注射（中位数-3），所有患者的眼球运动都有改善，上睑下垂,突增,和MRI扫描的肌肉增强。三名患者的眼内压和炎症升高，在一周内稳定下来，具有良好的解剖和功能结果。
结论：对于患有眼眶疾病的ROCM患者，应考虑经皮球后两性霉素B的辅助治疗方式，以保持眼功能。
方法：本前瞻性介入病例系列包括2021年5月至9月在印度北部三级护理中心就诊的7例确诊为COVID-19ROCM患者的7只眼睛。包括临床特征提示ROCM和早期眼眶受累的积极或康复的COVID-19病例。功能性内窥镜鼻窦手术后，根据对比增强磁共振成像(MRI)所涉及的肌肉,患者在单个眼部象限给予TRAMB3.5mg/ml.对患者进行为期12周的随访。
结果：所有患者均为糖尿病和COVID-19逆转录聚合酶链反应阳性。患者平均年龄为48.4岁±11岁,其中男性5例，女性2例。57.14%的病例累及左眼，42.85%的病例累及右眼。提出的投诉是上眼睑下垂（57.14％；n=4），峰值（28.57%；n=2），面部疼痛和肿胀（85.71％；n=6），鼻塞（57.14%；n=4）。4例患者的分期分布为3a(57.14%)，两名患者（28.57％），和4a在一个病人。给予TRAMB注射（中位数-3），所有患者的眼球运动都有改善，上睑下垂,突增,和MRI扫描的肌肉增强。三名患者的眼内压和炎症升高，在一周内稳定下来，具有良好的解剖和功能结果。
结论：对于患有眼眶疾病的ROCM患者，应考虑经皮球后两性霉素B的辅助治疗方式，以保持眼功能。
