Preoperative Administration of Amphotericin B in Orbital Mucormycosis Management: A Case Report

Abstract

This case report presents a 29-year-old male with diabetes mellitus who developed rhino-orbito-cerebral mucormycosis (ROCM) that was successfully treated with liposomal amphotericin B orbital injections. Despite emergent endoscopic debridement, the patient's disease progressed intracranially and intraorbitally, but he declined further surgical intervention. Subsequently, due to rapid acute vision loss, we initiated transcutaneous retrobulbar amphotericin B (TRAMB) injections. Following these injections, visual acuity, motility, and intraorbital fungal burden improved despite intracranial progression. This report highlights the benefits of TRAMB administration in aggressive fungal infections and explores the mechanisms behind its effectiveness, particularly in globe preservation. By targeting the infection in an area with a relatively robust blood supply, TRAMB reduces surgical difficulty and improves overall outcomes.

Keywords: TRAMB injections; amphotericin B; antifungal therapy; diabetes mellitus; fungal infection; globe preservation; intracranial extension; minimally invasive treatment; orbital mucormycosis; preoperative management.

Fig. 1

Preoperative coronal CT showing the sinonasal involvement of the infection.

Fig. 2

Table of the treatment course of 1 mL of 3.5 mg liposomal amphotericin B injections performed in the supramedial orbit. The table documents clinical improvements of vision from the injections. Abbreviations: APD, afferent pupillary defect; EOM, extraocular motility.

Fig. 3

( A, B ) Axial MRIs taken before and after the liposomal amphotericin B injections, showing the orbital improvements. ( C, D ) Coronal MRIs taken before and after the liposomal amphotericin B injections further highlight the orbital improvement. ( E, F ) Axial MRIs taken before and after the liposomal amphotericin B injections, showing the intracranial progression.

Fig. 4

( A ) Postoperative axial MRI showing the intracranial cuts where the fungus was resected. B ) Postoperative axial MRI showing decompressed optic nerve and drastic decrease in proptosis. ( C ) Postoperative coronal MRI showing decompressed optic nerve.