title: The Role of Adjunctive Therapies in the Management of Invasive Sino-Orbital Infection.
abstract: OBJECTIVE
  Invasive sino-orbital fungal infections are life-threatening complications of immunonosupression that are difficult to treat. Currently there are no standard treatment guidelines. The most widely accepted therapy includes parenteral anti-fungal therapy and surgical debridement of sinuses with orbital exenteration, a procedure that is not only disfiguring, but may increase morbidity. Injection of retrobulbar Liposomal Amphotericin B (L-AMB) is an alternative approach that provides local administration to infected tissues. The adjunct use of anti-fungal retrobulbar injections not been extensively reviewed in treating sino-orbital infection. We are reporting the multimodal approach of using L-AMB retrobulbar injections in combination with sinus debridement, intravenous (IV) anti-fungal therapy, and hyperbaric oxygen (HBO) for the management of sino-orbital infection.
  
  
  RESULTS
  Review of literature of 12 cases and retrospective evaluation of one patient with sino-orbital Aspergillus flavus infection on chemotherapy for T-cell acute lymphocytic leukemia treated with retrobulbar Amphotericin B, IV anti-fungal agents, and hyperbaric oxygen therapy. Clinical characteristics, radiographic features, management techniques, and clinical outcomes are described.
  
  
  CONCLUSIONS
  Retrobulbar Amphotericin B injection may be an effective adjunct to hyperbaric oxygen and parenteral anti-fungals in the control of sino-orbital fungal infections.
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina, U.S.A.
authors.forename: Betsy
authors.initials: B
authors.lastname: Colon-Acevedo
authors.forename: Jaya
authors.initials: J
authors.lastname: Kumar
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Richard
authors.forename: Julie A
authors.initials: JA
authors.lastname: Woodward
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D001231:Aspergillus flavus / Q000302:isolation & purification; D003131:Combined Modality Therapy; D003646:Debridement; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D015458:Leukemia, T-Cell / Q000188:drug therapy / Q000473:pathology; D009916:Orbital Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D010254:Paranasal Sinus Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B