Outcomes of surgical management in orbital cellulitis due to mucormycosis in patients recovered from COVID-19

Abstract

Purpose: To document the treatment outcomes of orbital cellulitis in COVID-19-associated mucormycosis cases after timely transcutaneous retrobulbar amphotericin B (TRAMB) injections and sinus debridement by functional endoscopic sinus surgery (FESS), with or without medial orbital wall decompression and lateral canthotomy. Methods: This retrospective observational study was conducted in the mucormycosis ward of a tertiary referral centre in Andhra Pradesh from May 2021 to September 2021. All patients with a history of COVID-19 infection and biopsy-proven, radiologically confirmed mucormycosis were included in the study and treated using a multidisciplinary approach with systemic and local antifungals and sinus debridement by FESS, with or without medial orbitotomy and lateral canthotomy. Results: Forty-six patients met the inclusion criteria. The identified risk factors were diabetes mellitus (80%), a history of steroid usage (59%) and raised serum ferritin levels (87%). The most common clinical presentation was diminution of vision with proptosis (65.2%), followed by ophthalmoplegia (54.34%). All patients received systemic antifungals and underwent FESS. TRAMB injections (three to six doses) were given to 44 patients. Of the 46 patients, 30 with mild to severe proptosis underwent medial orbital wall decompression, and 10 patients also lateral canthotomy. Clinical and radiological improvement was observed within 10 days postoperatively in 36 patients. Conclusion: In patients with orbital cellulitis secondary to mucormycosis, early surgical intervention under antifungal coverage may allow complete resolution of orbital mucormycosis, preventing vision loss, morbidity and mortality.

Keywords

• covid 19
• endoscopic medial orbital wall decompression
• lateral canthotomy
• rhino orbito cerebral mucormycosis