Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, , India.
Department of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Indian J Ophthalmol. 2023 Feb;71(2):452-456. doi: 10.4103/ijo.IJO_1382_22.
To describe the long-term outcomes of transcutaneous retrobulbar amphotericin B (TRAMB) in COVID-19-associated mucormycosis.
In total, 18 cases of COVID-19-associated mucormycosis were reviewed. In addition to the recommended treatment protocol, all patients were to be given 3.5 mg/ml/day of TRAMB for five days.
Of the 18 patients, 2 presented with stage 3a disease, 13 had stage 3c disease, and 3 patients had central nervous system (CNS) involvement (stage 4a and 4c). In addition to planned retrobulbar doses, five patients were given more while two patients received fewer injections (i.e., <5). At the last mean follow-up of 34.67 (±8.88) weeks, 11 patients were in radiological regression and 4 had stable disease while 2 patients had to undergo exenteration; one mortality was observed because of disease progression. Clinical regression in terms of visual and ptosis improvement was seen in seven and nine patients, respectively.
Rhino-orbito-cerebral mucormycosis is a serious condition which warrants an aggressive treatment strategy. In unprecedented situations witnessed recently, TRAMB turned out to be an effective and economical alternative. Though large randomized studies are needed to establish its efficacy, TRAMB still manages to halt progression and salvage the globe in significant number of patients, and hence its use should be encouraged on a case-to-case basis especially in developing countries with limited resources.
描述 COVID-19 相关毛霉病中经皮眶后两性霉素 B（TRAMB）的长期结果。
共回顾了 18 例 COVID-19 相关毛霉病患者。除了推荐的治疗方案外，所有患者均给予 3.5mg/ml/天的 TRAMB 治疗 5 天。
18 例患者中，2 例为 3a 期疾病，13 例为 3c 期疾病，3 例有中枢神经系统（CNS）受累（4a 和 4c 期）。除了计划的眶后剂量外，5 例患者给予了更多剂量，2 例患者给予了较少剂量（即<5 次）。在最后一次平均随访 34.67（±8.88）周时，11 例患者在影像学上出现消退，4 例患者疾病稳定，2 例患者不得不进行眼眶内容物剜除术；1 例患者因疾病进展而死亡。在视力和上睑下垂改善方面，分别有 7 例和 9 例患者出现临床消退。
鼻-眶-脑毛霉病是一种严重的疾病，需要采取积极的治疗策略。在最近出现的前所未有的情况下，TRAMB 已成为一种有效且经济的替代方案。虽然需要进行大规模的随机研究来确定其疗效，但 TRAMB 仍能阻止病情进展并挽救大量患者的眼球，因此应根据具体情况鼓励使用，特别是在资源有限的发展中国家。
