Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.
Indian J Ophthalmol. 2022 Mar;70(3):1019-1024. doi: 10.4103/ijo.IJO_2356_21.
To assess the outcome and response of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in post-coronavirus disease of 2019 (COVID-19) rhino-orbito-cerebral mucormycosis (ROCM) and to establish a scoring system in guiding treatment modalities.
An interventional, prospective study was done on 82 eyes of post-COVID-19 ROCM from May 2021 to July 2021. A comprehensive multi-departmental evaluation along with detailed ophthalmic examination, laboratory investigations, and radiological examination was done. Scoring points were given to each symptom, sign, and radiological features of orbit and the total score was taken. Based on these scores, severity of disease was grouped into A, B, and C corresponding to mild, moderate, and severe orbital ROCM. One milliliter of reconstituted liposomal amphotericin B was given to all patients every alternate day as three doses. Efficacy of these injections was assessed in all groups, even though other treatment modalities like orbital debridement and exenteration were considered for moderate and severe cases. Patients were followed up for a period of 8 weeks.
Out of 82 eyes, symptomatic improvement was seen in a major proportion (72%) of patients. A statistically significant improvement in scores was noted in group A (93% improved) with a P value of 0.002, while 68.4% showed improvement in group B (P-value- 0.0001). Group C with severe disease showed minimal improvement in post-injection scores of 41% (P-value 0.086), necessitating surgical intervention. No serious adverse effect of the drug or procedure was noted.
Significant improvement in scores of groups A and B highlights TRAMB as an effective and safe treatment modality in mild to moderate ROCM. It is an effective adjunct in severe cases, along with other interventions. Also, the scoring system helps in assessing the severity and guiding in management strategies.
评估经皮眶后注射两性霉素 B（TRAMB）治疗 2019 年冠状病毒病（COVID-19）后鼻-眶-脑毛霉菌病（ROCM）的结果和反应，并建立一个评分系统来指导治疗方式。
这是一项 2021 年 5 月至 7 月进行的针对 COVID-19 后 ROCM 的干预性、前瞻性研究。对所有患者进行了全面的多科室评估，包括详细的眼科检查、实验室检查和影像学检查。对每个症状、体征和眼眶的影像学特征给予评分点，并计算总分。根据这些评分，疾病的严重程度分为 A、B 和 C 三组，分别对应轻度、中度和重度眶内 ROCM。所有患者均给予每两天一次、每次 1 毫升的重组两性霉素 B 脂质体治疗，共 3 剂。即使考虑对中度和重度病例进行眼眶清创术和眶内容剜除术等其他治疗方式，也评估了这些注射的疗效。所有患者均随访 8 周。
在 82 只眼中，大多数（72%）患者的症状均有改善。A 组（93%的患者改善）的评分显著改善，差异有统计学意义（P 值=0.002），而 B 组（68.4%的患者改善）（P 值=0.0001）的评分也有改善。C 组（重度疾病）的注射后评分改善最小，为 41%（P 值=0.086），需要手术干预。未观察到药物或治疗的严重不良反应。
A 组和 B 组的评分显著改善，提示 TRAMB 是治疗轻度至中度 ROCM 的有效且安全的治疗方法。在严重病例中，TRAMB 与其他干预措施一起作为有效的辅助治疗手段。此外，评分系统有助于评估严重程度并指导管理策略。
