Preoperative Administration of Amphotericin B in Orbital Mucormycosis Management: A Case Report

TL;DR

A patient with a severe fungal infection in the eye area was treated with amphotericin B injections, which helped preserve vision and reduce infection despite disease progression elsewhere.

Contribution

Demonstrates the effectiveness of transcutaneous retrobulbar amphotericin B in managing aggressive orbital fungal infections.

Findings

TRAMB injections improved visual acuity and intraorbital fungal burden despite intracranial progression.

The treatment reduced surgical difficulty and preserved the eye in a patient who declined further surgery.

The method targets the infection in a well-vascularized area, enhancing therapeutic outcomes.

Abstract

This case report presents a 29-year-old male with diabetes mellitus who developed rhino-orbito-cerebral mucormycosis (ROCM) that was successfully treated with liposomal amphotericin B orbital injections. Despite emergent endoscopic debridement, the patient's disease progressed intracranially and intraorbitally, but he declined further surgical intervention. Subsequently, due to rapid acute vision loss, we initiated transcutaneous retrobulbar amphotericin B (TRAMB) injections. Following these injections, visual acuity, motility, and intraorbital fungal burden improved despite intracranial progression. This report highlights the benefits of TRAMB administration in aggressive fungal infections and explores the mechanisms behind its effectiveness, particularly in globe preservation. By targeting the infection in an area with a relatively robust blood supply, TRAMB reduces surgical difficulty and improves overall outcomes.

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