Abstract：
Acute invasive fungal sinusitis (AIFS) is an aggressive disease with significant mortality and morbidity. Surgical debridement is a mainstay of treatment. However, orbital involvement may limit its efficacy and is an independent risk factor for mortality. Traditionally, orbital exenteration has been utilized in cases with orbital invasion and ophthalmoplegia or vision loss. Retrobulbar liposomal amphotericin B injection may improve disease control and has the potential to spare the morbidity associated with exenteration. In this video article, we document the use of serial endonasal debridement with retrobulbar injections to salvage the eye in a patient with significant orbital involvement. A 28-year-old immunocompromised female patient presented with acute onset restricted right extraocular movement, progressive orbital pain, V2 trigeminal numbness, and 20/40 vision. The patient underwent recurrent debridement and retrobulbar injections of liposomal amphotericin B. Her serial exams, including changes in extraocular muscle appearance and gradual improvement in extraocular movement, were documented. The exam six months after initial presentation demonstrated 20/20 vision, minimal extraocular movement restriction, and proper healing of the orbit and ethmoid. The salvage of the patient\'s orbit suggests that liposomal amphotericin B injections with debridement may be a viable treatment alternative in patients with acute invasive fungal sinusitis and orbital involvement.
摘要：
急性侵袭性真菌性鼻窦炎(AIFS)是一种侵袭性疾病,具有显著的死亡率和发病率。手术清创是治疗的主要手段。然而,眼眶受累可能限制其疗效,并且是死亡的独立危险因素.传统上,在患有眼眶侵犯和眼肌麻痹或视力丧失的情况下，已使用了眼眶切除术。球后注射两性霉素B脂质体可以改善疾病控制，并有可能避免与切除相关的发病率。在这篇视频文章中，我们记录了在有严重眼眶受累的患者中使用连续鼻内清创结合球后注射来挽救眼睛的方法.一名28岁的免疫功能低下的女性患者出现急性发作的限制性右眼外运动，进行性眼眶疼痛,V2三叉神经麻木，20/40视力患者接受了复发性清创术和球后注射脂质体两性霉素B。包括眼外肌外观的变化和眼外运动的逐渐改善，被记录在案。初次陈述后六个月的检查显示出20/20的视力，最小眼外运动限制，轨道和筛骨的适当愈合。患者眼眶的抢救表明，在急性侵袭性真菌性鼻窦炎和眼眶受累的患者中，脂质体两性霉素B注射清创术可能是一种可行的治疗选择。
