2025 Poster Presentations
P035: PRE-OPERATIVE ADMINISTRATION OF AMPHOTERICIN B IN ORBITAL MUCORMYCOSIS: A NOVEL APPROACH TO MANAGING A LIFE-THREATENING CONDITION
Russel T Wagner, BS; Amin B Kassam, MD; Neilkamal Mundi, MD; Sammy Khalili, MD; Stephen Winkler, MD; Intent Medical Group Neurosciences, Endeavor Health
This case report highlights the use of transcutaneous retrobulbar amphotericin B (TRAMB) injections as a novel, globe-saving pre-operative intervention in the management of rhino-orbito-cerebral mucormycosis (ROCM) in a 29-year-old male with diabetes mellitus and diabetic ketoacidosis (DKA). The patient initially presented with extensive sino-orbital and intracranial fungal infection, confirmed as mucormycosis following endoscopic debridement. Despite surgical intervention, the infection progressed intracranially, but the patient initially declined further surgery. Upon further intracranial progression and rapid vision deterioration in the right eye, the decision was made to initiate TRAMB injections. Over the course of six injections, the patient’s vision stabilized, improving from 20/100 to 20/50, and the progression of orbital disease was halted. This allowed for globe-sparing surgery, avoiding the need for exenteration. This report demonstrates the potential of TRAMB as an effective adjunct therapy in stabilizing orbital mucormycosis, reducing surgical complexity, and preserving vision in aggressive fungal infections. The case contributes to growing evidence that supports TRAMB as a safe, minimally invasive alternative to more aggressive surgical interventions like exenteration in ROCM patients.
Pre-operative sagittal MRI showing fungal invasion into the right ethmoid, frontal, and sphenoid sinuses.
Pre-operative axial MRI showing fungal invasion from the right frontal sinus extending 4.04 cm into the frontal lobe, with additional growth into the right orbital wall, creating proptosis
Post-operative axial MRI view showing reduced orbital proptosis and decreased fungal burden