Outcomes of a Modified Treatment Ladder Algorithm Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital Sinusitis.

Am J Ophthalmol

From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA. Electronic address:

Published: May 2022

AI Article Synopsis

  • The study aimed to determine if a new treatment approach using transcutaneous retrobulbar amphotericin B (TRAMB) could decrease the need for exenteration (removal of eye tissues) in patients with invasive fungal rhino-orbital sinusitis while maintaining survival rates.
  • Researchers analyzed data from 50 patients over two periods: before and after TRAMB was included in the treatment ladder (from 1999 to 2020).
  • Results showed a significant reduction in the risk of exenteration post-2015 (9.1%) compared to pre-2015 (36.4%) while mortality rates remained similar, indicating that TRAMB could be beneficial without increasing the risk of death.

Article Abstract

Purpose: To assess whether a modified treatment ladder algorithm incorporating transcutaneous retrobulbar amphotericin B (TRAMB) for invasive fungal rhino-orbital sinusitis can reduce the risk of exenteration without compromising survival.

Design: Retrospective, comparative clinical study with historical control subjects.

Methods: Fifty consecutive patients with biopsy-proven invasive fungal sinusitis and radiographic evidence of orbital involvement were evaluated at a single tertiary institution from 1999-2020. TRAMB was incorporated as part of the treatment algorithm in 2015. Demographics, underlying immune derangement, infective organism, ophthalmic examination, surgical care, and survival were compared in a quasiexperimental pre-post format, dividing patients into a pre-2015 group and a post-2015 group. Risk of exenteration and mortality were the primary outcomes.

Results: Baseline characteristics did not differ significantly between the 2 groups. Nearly all patients underwent a surgical intervention, most commonly functional endoscopic sinus surgery with debridement. TRAMB was administered to 72.7% of the post-2015 group. Exenteration was more common in the pre-2015 group (36.4% vs 9.1% [95% confidence interval {CI} 5.2-48.8]; P = .014), while mortality was similar (40.0% vs 36.7% [95% CI -22.1 to 29.3]; P = .816). After adjusting for potential confounders, patients treated after 2015 were found to have lower risk of exenteration (relative risk 0.28 [95% CI 0.08-0.99]; P = .049) and similar risk of mortality (relative risk 1.04 [95% CI 0.50-2.16]; P = .919).

Conclusion: Compared with historical control subjects, patients with invasive fungal rhino-orbital sinusitis who were treated with a modified treatment ladder algorithm incorporating TRAMB had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.

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http://dx.doi.org/10.1016/j.ajo.2021.05.025DOI Listing

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