Role of local amphotericin B therapy for sino-orbital fungal infections

Purpose: Sino-orbital fungal infections are serious complications of diabetes and immunosuppression. Standard treatments include surgical debridement of the involved tissues with possible orbital exenteration, intravenous antifungal therapy, and improvement of the host's immunocompetence and metabolic state, when possible. The role of conservative orbital debridement combined with local amphotericin B irrigations in the treatment of these patients was evaluated. Methods: The records of seven consecutive patients with sino-orbital fungal infections, who were treated with limited surgical debridement and local and systemic amphotericin B therapy, were reviewed. The underlying disorders of these patients included acute lymphoblastic leukemia, immunosuppression after renal transplantation, diabetes mellitus, and acquired immunodeficiency syndrome. The fungal species identified included Rhizopus, Mucor, and Aspergillus. Results: Follow-up ranged from 4 months to 4 years. All patients retained their preoperative visual acuities. Only one patient ultimately underwent an orbital exenteration for progressive orbital fungal infection. The remaining patients had either complete or incomplete (without further progression) resolution of their fungal infection. Two of the seven patients died of unrelated causes, and no patient died of uncontrolled fungal spread. Conclusions: Conservative orbital debridement with local amphotericin B irrigations is an effective adjunct in the control of sino-orbital fungal infections, especially in patients with reversible immunosuppression and good preoperative visual acuities.