Indications for orbital exenteration in mucormycosis.
OBJECTIVE
To determine whether evidence-based standards exist regarding the indications for orbital exenteration in patients with orbital mucormycosis.


METHODS
A literature review was performed of 113 articles (1943 to 2004). Factors possibly related to patient survival were analyzed. Additionally, a survey was sent to all ASOPRS Fellowship Preceptors to ascertain the frequency, outcome, treatment modalities, and indications for exenteration by these practicing physicians.


RESULTS
For published cases, parameter estimates (PE <or= 1.00) indicated that patients with mucormycosis with age >46 years, frontal sinus involvement, and fever were less likely to survive compared with patients without these conditions. Patients treated with amphotericin B (OR, 4.476) and those with diabetes (OR, 4.987) were more likely to survive compared with patients without these conditions. Exenterated patients with fever were more likely to survive compared with nonexenterated patients with fever (P=0.0468). Thirty-four ASOPRS Fellowship Preceptors received surveys; 26 (76%) completed the survey. Responses to specific survey questions showed a varied experience and indication for exenteration throughout the country.


CONCLUSIONS
: Our study underscores the lack of adequate data regarding the evaluation of treatment of orbital mucormycosis. No standard of care currently exists to guide physicians on when exenteration may benefit a mucormycosis patient. Further study is needed to determine which variables indicate the extent of disease and which variables or analytic scheme might predict the progression of orbital mucormycosis with or without exenteration.
Hargrove
Roderick N
RN
Department of Ophthalmology, The Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. rhargro1@utmem.edu
Wesley
Ralph E
RE
Klippenstein
Kimberly A
KA
Fleming
James C
JC
Haik
Barrett G
BG
D003695:Delivery of Health Care / Q000592:standards; D019317:Evidence-Based Medicine; D015821:Eye Infections, Fungal / Q000601:surgery*; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009091:Mucormycosis / Q000601:surgery*; D017233:Orbit Evisceration / Q000706:statistics & numerical data*; D009916:Orbital Diseases / Q000601:surgery*; D017410:Practice Guidelines as Topic