CT-Scan Guided Intra-orbital Amphotericin Injection in COVID-19-associated Mucormycosis, a pilot study

Abstract

Purpose : A high incidence of sinu-orbital Mucormycosis as a fulminant and opportunistic fungal infection happened following the COVID-19 pandemic. Traditionally, patients with apical or extensive orbital involvement are candidates for exenteration. We designed and applied CT scan guided orbital amphotericin C delivery. In this study we aimed to report this novel technique and results of this method in control of orbital mucormycosis with apical involvement.

Methods : A high incidence of sinu-orbital Mucormycosis as a fulminant and opportunistic fungal infection happened following the COVID-19 pandemic. Thus named as CAM. Traditionally, patients with orbital mucormycosis with apical or extensive involvement are considered hopeless for saving the eye. We designed and applied CT scan guided orbital amphotericin C delivery.

Results : A total of thirty patients with mean age of 52±11.86 were enrolled in this study. Twenty-three (76.7%) patients were male; group A: 11 (73.3%) and B: 12 (80%). The majority of the patients in both group were diabetics (A: 10 (66.7%), B: 10 (76.9%)). Most patients in both groups had received corticosteroids and antiviral therapy for their recent COVID-19, 23 (82.1%) and 25 (89.3%), respectively. No patient in group A underwent exenteration. Eleven (78.6%) patients in group B underwent orbital exenteration. Of the 6 expired patients, 5 (83.3%) were in group B (P<0.0001). Peri-orbital ecchymosis and intracranial air extension were observed in 2 (13.3%) and 1 (6.7%) in group A patients, respectively.

Conclusions : Intra-orbital amphotericin injection under CT-guidance can be considered as a highly effective method in patients with orbital mucormycosis. This method may decrease exenteration without increasing mortality of patients.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

A 62 year-old man with large left orbital apex mucormycosis lesion. A. CT guided interventional orbital amphotericin B injection. Before injection. Short arrow is CT guide for projection and entry level. Long arrow shows large orbital apex phlegmon and ischemic lesion. B. metallic stylus. C. Entry and dispersion into lesion is confirmed by injecting small air bubble (medium arrow). Short arrow is showing canula. D, E.T2 weighed orbital MRI showing remarkable reduction of heterogenous large apical lesion two months after guided orbital apex amphotericin C delivery. The patient showed recovery of eyelid ptosis and extra-ocular movements.