Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis.

Prabhakar Singh, Abhishek Gupta, Sravani Reddy Sanepalli, Amit Raj

BMJ case reports 2022 Mar 31

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We aim to highlight the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in cases of rhino-orbital mucormycosis. With the COVID-19 pandemic a rapid surge in the number of cases of rhino-orbital mucormycosis has been noted. The gold standard treatment for the progressive orbital disease is exenteration; however, organ salvage should be attempted, when possible. Here comes the role of TRAMB injection. We present a case of a man in his 70s, a known diabetic, who recovered from COVID-19 pneumonia but developed left-sided axial proptosis with orbital apex syndrome and ophthalmic artery occlusion secondary to rhino-orbital mucormycosis. The patient underwent debridement of paranasal sinuses and received intravenous liposomal amphotericin-B and three TRAMB injections. After three TRAMB injections significant improvement in extraocular movements, proptosis and ptosis was noted. An early intervention in orbital disease can avert a more radical procedure. © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Prabhakar Singh, Abhishek Gupta, Sravani Reddy Sanepalli, Amit Raj. Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis. BMJ case reports. 2022 Mar 31;15(3)