Brodie Frank L, Kalin-Hajdu Evan, Kuo Debbie S, Hirabayashi Kristin E, Vagefi Reza, Kersten Robert C
Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
Department of Ophthalmology, Duke University, Durham, NC, USA.
Am J Ophthalmol Case Rep. 2016 Feb 10;1:8-10. doi: 10.1016/j.ajoc.2016.01.003. eCollection 2016 Apr.
To describe a complication of retrobulbar amphotericin B injections in the treatment of invasive rhino-orbital .
27 year-old renal transplant recipient presented with a two-week history of headache, binocular diplopia and proptosis of the left eye. Endonasal biopsy on hospital day 3 confirmed the diagnosis of rhino-orbital invasive involving the left orbital apex.In addition to systemic antifungal treatment and cessation of immunosuppression, retrobulbar amphotericin B injections (3.5 mg/1 ml) combined with endoscopic local debridement were initiated when the patient developed progressive visual loss. Retrobulbar injections were administered on hospital days 8, 10, 14, 17, and 20. Endoscopic debridement occurred on hospital days 10 and 16.After the fifth retrobulbar amphotericin B injection, the patient developed acute orbital compartment syndrome with intraocular pressures ranging from 47 to 86 mmHg and vision declined to 20/200, requiring emergent lateral canthotomy and superior and inferior cantholysis. Close observation without further intervention resulted in return of vision to 20/20 and normalization of intraocular pressure.
Retrobulbar amphotericin B in combination with local debridement may be considered an alternative to exenteration for invasive aspergillosis secondary to reversible immunosuppression. To the authors' knowledge, orbital compartment syndrome secondary to retrobulbar amphotericin B administration has not previously been reported. Patients should be counseled on the risk of severe local inflammation due to amphotericin B. More research is needed to establish the most appropriate dosing, frequency, and duration of retrobulbar amphotericin B injections in the treatment of life-threatening infections.
