Indications for orbital exenteration in mucormycosis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Oncology

Background:

• Orbital mucormycosis is a severe fungal infection requiring aggressive management.
• Orbital exenteration is a radical surgical procedure with significant morbidity.
• Current guidelines for orbital exenteration in mucormycosis are not well-established.

Purpose of the Study:

• To investigate the existence of evidence-based standards for orbital exenteration indications in orbital mucormycosis.
• To analyze factors influencing survival in patients with orbital mucormycosis.
• To assess current clinical practices and indications for exenteration among specialists.

Main Methods:

• A comprehensive literature review of 113 articles published between 1943 and 2004.
• Analysis of patient survival factors from published cases.
• A survey distributed to 34 ASOPRS Fellowship Preceptors regarding exenteration practices.

Main Results:

• Older age (>46 years), frontal sinus involvement, and fever were associated with decreased survival in mucormycosis.
• Amphotericin B treatment and diabetes were linked to improved survival.
• Exenteration in febrile patients showed a survival benefit (P=0.0468).
• Survey responses revealed varied exenteration indications and experiences among physicians.

Conclusions:

• Significant data gaps exist in evaluating orbital mucormycosis treatment.
• No established standard of care guides the use of exenteration for mucormycosis.
• Further research is essential to identify predictive variables for disease progression and optimize treatment strategies.