amphotericin-b and Retinal-Artery-Occlusion

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Blepharoptosis; Blindness; Cerebrospinal Fluid Leak; Debridement; Diabetes Mellitus, Type 2; Endoscopy; Humans; Hyphae; Intraoperative Complications; Magnetic Resonance Angiography; Male; Middle Aged; Mucormycosis; Orbit; Orbit Evisceration; Orbital Diseases; Paranasal Sinuses; Retinal Artery Occlusion; Sinusitis; Treatment Outcome