Varshitha B M

Abstract

Aims: To know the incidence and treatment outcome of various ocular manifestations of allergic fungal pan sinusitis. Materials and Methods: A prospective study was conducted in a medical college hospital in south India for a period of 2 years which included all the cases of allergic fungal pansinusitis presented to the hospital. The cases were diagnosed by Bent-Kuhn criteria. The cases with ophthalmologic involvement were included in the study. CT scan of PNS, brain, orbit were done and the disease extent was noted. Cases with eye involvement were planned for surgical debridement after an initial prednisolone oral 1mg/kg over 2 weeks. Surgical debridement was done endoscopically by a team of ENT surgeon, oculoplastic surgeon and neurosurgeon. Histopathologic examination was done. Post-surgery the steroids were tapered over 2 weeks. Post operative follow up was done every day for first week followed by weekly once till a month and every 6 monthly once for a year in the form of clinical examination, CT scan was repeated after a week during post op period. In cases with suspected recurrence CT PNS was performed. Their outcomes were analyzed. Results: 6 cases (33%) had ocular involvement. Proptosis was the most common (28%) finding followed by epiphora (22.2%), ophthalmoparesis (22.2%), diplopia (22.2%), ophthalmoplegia (11.%), complete loss of vision (5%). Surgical intervention led to early recovery in proptosis followed by others except with PL -ve case. Conclusion: Early treatment in AFPS prevents vision loss and has better outcomes.   Keywords: Allergic Fungal Pan sinusitis, Proptosis, epiphora

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Abstract

Purpose: To compare whether treatment incorporating retrobulbar liposomal amphotericin B for rhino-orbital mucormycosis in ongoing covid 19 time can reduce the risk of exenteration compared to treatment with intravenous liposomal amphotericin B without compromising the survival rate. Materials and Methods: In this retrospective, comparative institutional study 23 patients of biopsy-proven mucormycosis and radiographic evidence of orbital involvement were enrolled and 13 were divided into group A and 10 in group B. Group A consists of patients who were treated with retrobulbar liposomal amphotericin B and group B consists of patients who were treated with intravenous liposomal amphotericin B. Results: In group A, out of 13 patients, only one patient underwent exenteration and the patient survived post exenteration. Among the other 12 patients, 10 patients survived. In group B, out of ten, four patients were subjected to exenteration, out of which two survived. Among the other six patients without exenteration, five of them survived. Conclusion: In comparison, patients who were treated with retrobulbar amphotericin B had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.   Keywords: Mucormycosis, Amphotericin B, Exenteration, Retrobulbar

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