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Acute Invasive Fungal Rhino-Orbital Sinusitis: Lessons Learned and the Path Forward
M Reza Vagefi
Presenter:
M. Reza Vagefi, MD
Authors:
Affiliation:
None
Purpose: To review our experience in the presentation, diagnosis, and treatment of acute invasive fungal rhino-orbital sinusitis (AIFROS).
Methods: Retrospective review.
Results: Patients infected with Mucor or Rhizopus species had significantly worse visual outcomes compared to those with Aspergillus (6–7 lines worse; P = 0.001). Endoscopic sinus surgery was associated with improved visual acuity (6–7 lines better; P < 0.001). Orbital exenteration was linked to poorer vision (P = 0.01) without a corresponding survival benefit. Diabetes was associated with decreased mortality (P = 0.04), while neutropenia increased the risk of death tenfold (P = 0.02). Undergoing multiple surgeries was associated with improved survival (P = 0.04). Patients treated with transcutaneous retrobulbar amphotericin B (TRAMB) demonstrated better final visual acuity (P = 0.048) and a lower risk of exenteration (P = 0.049). Overall mortality rates were similar between TRAMB and non-TRAMB groups (P = 0.919).
Conclusions: AIFROS caused by Mucormycota is associated with worse visual and survival outcomes. Early and aggressive surgical debridement improves both survival and visual prognosis. Orbital exenteration does not provide a survival advantage. TRAMB may enhance globe preservation without increasing mortality.