Supplementary Material for: Transcutaneous Retrobulbar Amphotericin B injection treatment for invasive fungal rhino-orbital sinusitis – case report

Introduction: Invasive fungal rhino-orbital sinusitis is a rare and life-threatening condition that occurs in immunosuppressed patients. This article aims to describe the case of a patient with bilateral orbital mucormycosis treated with right orbital exenteration and transcutaneous retrobulbar amphotericin B (AMPB) in the left orbit.
Case Presentation: A 61-year-old diabetic woman, immunosuppressed due to treatment with immunotherapy for breast cancer and systemic corticosteroid for sarcoidosis, was admitted to our hospital with complaints of severe headache, fever and complete right visual loss. Imaging exams demonstrated an invasive pansinusitis with right orbital apex involvement, extension to frontal cerebral space and an inflammatory swelling in the medial aspect of the left orbit with extra-conal extension. These findings corroborated the diagnosis of rhino-orbital mucormycosis with intracranial extension. Initial treatment included systemic antifungal therapy and necrotic tissue debridement, both encephalic and sinonasal. Since there was a complete right orbital apex and optic nerve involvement, she was treated with right orbital exenteration. The left eye presented good visual acuity (8/10 Snellen chart) and no signs of afferent or efferent pathway involvement. Regarding the left orbital soft tissue involvement, this patient was proposed to transcutaneous retrobulbar injections of 1 mL of 3.5mg/mL of amphotericin B. She received a total of 6 injections, with clinical stability and radiographic signs of improvement regarding the left orbital involvement of the infection.
Conclusion: Transcutaneous retrobulbar injection of AMPB seems to be a valid approach for specific cases of rhinosinus mucormycosis with orbital invasion, allowing for orbital preservation without compromising patient survival.