Shabana Reham Refaat, Eldesouky Mohamed Ashraf, Elbedewy Hazem A
Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Gharbeya, Egypt.
Clin Ophthalmol. 2022 Jun 11;16:1933-1940. doi: 10.2147/OPTH.S366067. eCollection 2022.
To construct a simple management algorithm for cases with orbital mucormycosis during the COVID-19 era.
Retrospective study included records of 30 Egyptian patients with post COVID-19 orbital mucormycosis. They underwent full clinical examination, laboratory investigations, Computed tomography (CT)/magnetic resonance imaging (MRI) of the paranasal sinuses and pathological specimen examination. The proposed algorithm was based on all the available data of the included patients.
The mean age of the studied patients was 62.47±11.13 years; 56.6% were females and 63.3% had uncontrolled diabetes mellitus. The main presentation was Orbital apex syndrome (OAS) in 43.3% of the cases. Twenty-six patients (86.6%) received systemic liposomal amphotericin B, while 4 patients (13.3%) received posaconazole. Orbital exenteration was done in 6 patients (20.0%), 4 of them died (66.7%). Twenty-four patients (80%) survived with clinical but not with visual improvement.
Systemic antifungal treatment and functional endoscopic sinus surgery (FESS) with extensive debridement of involved necrotic tissues were the main steps to control ROCM. Orbital exenteration should be kept for cases with periorbital tissue affection as it did not increase the final cure rate. The proposed management algorithm is supposed to be simple and easy to follow.
构建一种适用于新冠疫情时代眼眶毛霉菌病病例的简单管理算法。
回顾性研究纳入了30例新冠后眼眶毛霉菌病埃及患者的记录。他们接受了全面的临床检查、实验室检查、鼻窦计算机断层扫描（CT）/磁共振成像（MRI）以及病理标本检查。所提出的算法基于纳入患者的所有可用数据。
研究患者的平均年龄为62.47±11.13岁；56.6%为女性，63.3%患有未控制的糖尿病。主要表现为眼眶尖综合征（OAS），占病例的43.3%。26例患者（86.6%）接受了全身性脂质体两性霉素B治疗，而4例患者（13.3%）接受了泊沙康唑治疗。6例患者（20.0%）进行了眼眶内容物剜除术，其中4例死亡（66.7%）。24例患者（80%）存活，临床症状有所改善，但视力未改善。
全身性抗真菌治疗以及功能性鼻内镜鼻窦手术（FESS）并广泛清除受累坏死组织是控制眼眶毛霉菌病的主要步骤。对于眶周组织受累的病例应保留眼眶内容物剜除术，因为它并未提高最终治愈率。所提出的管理算法应该简单且易于遵循。
