Retrobulbar Injection of Amphotericin B in the Management of Acute Invasive Fungal Sino-Orbital Infections

Objective: Treatment for acute invasive fungal rhinosinusitis consists of systemic antifungal therapy, early and aggressive surgical debridement, and reversal of immunosuppression. When the orbit is involved, the question is raised whether or not to perform orbital exenteration to gain local control. Alternatives have been proposed to spare the orbit such as retrobulbar injection of antifungal medication. Methods: We present a series of 2 cases of invasive fungal sino-orbital infections treated in our institution. When local control could not be obtained with systemic therapy and surgery, both were successfully treated with additional retrobulbar injections of liposomal amphotericin B 3.5 mg/mL. We reviewed the literature for comparable cases and studies comparing retrobulbar injections to orbital exenteration. Results: In our experience, a series of retrobulbar injection with liposomal amphotericin B 3.5 mg/mL was effective in 2 cases of orbital involvement, preventing an orbital exenteration. A review of the literature showed comparable cases in which local control was obtained with retrobulbar injections and 2 retrospective cohort studies which found similar mortality rates when comparing retrobulbar injections to orbital exenteration. Conclusion: We therefore conclude that retrobulbar injections with liposomal amphotericin B are a safe and efficient treatment for invasive fungal sino-orbital infections to obtain local control. It is a minimally invasive procedure preventing orbital exenteration. Cite this article as: De Kezel M, Van Zele T, Ninclaus V, Coppens M. Retrobulbar injection of amphotericin B in the management of acute invasive fungal sino-orbital infections. B-ENT. 2023;19(4):258-266.