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RE Turbin, SA Khoobiar, P Langer, K Amesur, L Frohman, F Warren, S Baredes, JS Kennerdell; Adjuvant Therapy for Invasive Sino-orbital Fungal Infection . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2637.
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Purpose:To report the authors experience in the management of invasive sino-orbital fungal infection treated with retrobulbar injection and surgical or post-operative irrigation of amphotericin B (AmphB) as an adjuvant to systemic antifungal therapy, and limited, conservative, biopsy or debridement procedures. Methods:Retrospective chart review of a consecutive case series. Data concerning comorbid conditions, vision, motility and orbital examination, radiographic findings, and clinical outcome are provided. Fungal species, treatment data, and surgical procedures are described. Results:Five patients suffered biopsy proven invasive fungal sino-orbital infection (2 rhizopus, 1 mucor, 1 aspergillosis, 1 rhodotorula mucilaginosa/alternaria /hormographiella) related to comorbid conditions (leukemia, renal transplant, diabetic keto-acidosis, corticosteroid therapy, retained intraorbital foreign body) Adjuvant therapy supplementing systemic antifungal therapy included retrobulbar/peribulbar injection ( 3-5 cc of 2mg/cc AmphB) and sino-orbital irrigation (50-500cc of 0.2- 0.5mmg/cc AmphB) Two patients who presented prior to onset of complete blindness (counting fingers, and 20/40 soon worsening to no light perception) in the affected eye maintained useful visual function at latest examination (20/80 and 20/25, respectively) Five patients showed improvement in orbital and motility examination. No patient required orbital exenteration, or extensive disfiguring facial debridement. Conclusion:Adjuvant orbital therapy with Amphotericin B is safe and appears effective in controlling orbital fungal infection. In selected cases, it may prevent disfiguring surgery, may be associated with improvement in ophthalmoplegia, and may preserve visual function when begun prior to onset of complete blindness.
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