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Abdulbaki H, Callander JK, Fastenberg JH, Russell MS, Vagefi MR, Kersten RC, Loftus PA. Transcutaneous Retrobulbar Amphotericin B Injection for Invasive Fungal Sinusitis with Orbital Involvement: A Systematic Review. Am J Rhinol Allergy 2024:19458924241254422. [PMID: 38772559 DOI: 10.1177/19458924241254422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND Orbital involvement of invasive fungal sinusitis (IFS) is an ominous prognostic marker that should prompt rapid intervention. Transcutaneous retrobulbar administration of amphotericin B (TRAMB) is an off-label adjunctive treatment that can increase drug penetrance into diseased orbital tissue. To date, there is a lack of consensus regarding the use of TRAMB for treatment of IFS with orbital involvement. OBJECTIVE This systematic review aims to synthesize the indications, efficacy, and potential complications of TRAMB. METHODS PubMed, EMBASE, and Web of Science databases were probed for systematic review. Article search was conducted through June 2023 using the keywords "invasive fungal sinusitis," "invasive fungal rhinosinusitis," "rhino-orbital mucormycosis," "rhinosinusitis," "orbital," "retrobulbar," and "amphotericin." RESULTS In suitable cases as determined by radiologic and clinical evaluation, TRAMB administration has the potential to improve orbital salvage rates and improve versus stabilize visual acuity. Treatment complications are more likely with deoxycholate than with liposomal amphotericin formulations. The existing literature describing use of TRAMB is limited due to its retrospective nature, but the increase in IFS cases since 2020 due to the COVID pandemic has broadened the literature. CONCLUSIONS TRAMB is an effective adjunctive treatment in IFS with mild-to-moderate orbital involvement when used in combination with standard of care debridement, systemic antifungal therapy, and immunosuppression reversal. Prospective longitudinal studies and multi-institutional randomized trials are necessary to determine the definitive utility of TRAMB.
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Affiliation(s)
- Hasan Abdulbaki
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Judd H Fastenberg
- Department of Otolaryngology-Head and Neck Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA
| | - Matthew S Russell
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Robert C Kersten
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
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Dallalzadeh LO, Ediriwickrema LS, Fung SE, Men CJ, Kossler AL, Kupcha AC, Mawn LA, Burkat CN, van Landingham SW, Conger JR, Simmons B, Pham C, Akella SS, Setabutr P, Ho T, Couch SM, Kim JS, Demirci H, Korn BS, Kikkawa DO, Liu CY. Transcutaneous retrobulbar amphotericin B for rhino-orbital-cerebral mucormycosis: a multi-center retrospective comparative study. Orbit 2024; 43:41-48. [PMID: 36880205 DOI: 10.1080/01676830.2023.2186435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM). METHODS In this retrospective case-control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (-TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality. RESULTS Among eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality. CONCLUSIONS Patients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
| | - Lilangi S Ediriwickrema
- Division of Ophthalmic Plastic and Reconstructive Surgery, Gavin Herbert Eye Institute, UC Irvine, Irvine, California, USA
| | - Sammie E Fung
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
| | - Clara J Men
- Division of Oculoplastic and Orbital Surgery, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Andrea L Kossler
- Division of Oculoplastic and Orbital Surgery, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anna C Kupcha
- Division of Oculoplastics and Orbital Disease, Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Louise A Mawn
- Division of Oculoplastics and Orbital Disease, Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Cat N Burkat
- Oculoplastic, Orbital, & Cosmetic Facial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Suzanne W van Landingham
- Oculoplastic, Orbital, & Cosmetic Facial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Jordan R Conger
- Division of Ophthalmic Plastic and Reconstructive Surgery, Gavin Herbert Eye Institute, UC Irvine, Irvine, California, USA
| | - Brittany Simmons
- Division of Oculoplastic, Orbit, and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Chau Pham
- Division of Oculoplastic, Orbit, and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Sruti S Akella
- Oculoplastic and Reconstructive Surgery Service, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Pete Setabutr
- Oculoplastic and Reconstructive Surgery Service, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Tiffany Ho
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Steven M Couch
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jane S Kim
- Division of Eye Plastic, Orbital and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Hakan Demirci
- Division of Eye Plastic, Orbital and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
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Jati S, Mahata S, Das S, Chatterjee S, Mahata SK. Catestatin: Antimicrobial Functions and Potential Therapeutics. Pharmaceutics 2023; 15:1550. [PMID: 37242791 PMCID: PMC10220906 DOI: 10.3390/pharmaceutics15051550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
The rapid increase in drug-resistant and multidrug-resistant infections poses a serious challenge to antimicrobial therapies, and has created a global health crisis. Since antimicrobial peptides (AMPs) have escaped bacterial resistance throughout evolution, AMPs are a category of potential alternatives for antibiotic-resistant "superbugs". The Chromogranin A (CgA)-derived peptide Catestatin (CST: hCgA352-372; bCgA344-364) was initially identified in 1997 as an acute nicotinic-cholinergic antagonist. Subsequently, CST was established as a pleiotropic hormone. In 2005, it was reported that N-terminal 15 amino acids of bovine CST (bCST1-15 aka cateslytin) exert antibacterial, antifungal, and antiyeast effects without showing any hemolytic effects. In 2017, D-bCST1-15 (where L-amino acids were changed to D-amino acids) was shown to exert very effective antimicrobial effects against various bacterial strains. Beyond antimicrobial effects, D-bCST1-15 potentiated (additive/synergistic) antibacterial effects of cefotaxime, amoxicillin, and methicillin. Furthermore, D-bCST1-15 neither triggered bacterial resistance nor elicited cytokine release. The present review will highlight the antimicrobial effects of CST, bCST1-15 (aka cateslytin), D-bCST1-15, and human variants of CST (Gly364Ser-CST and Pro370Leu-CST); evolutionary conservation of CST in mammals; and their potential as a therapy for antibiotic-resistant "superbugs".
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Affiliation(s)
- Suborno Jati
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA 92093, USA;
| | - Sumana Mahata
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA;
| | - Soumita Das
- Department of Biomedical and Nutritional Science, University of Massachusetts Lowell, Lowell, MA 01854, USA;
| | - Saurabh Chatterjee
- Department of Medicine, University of California Irvine, Irvine, CA 92697, USA;
| | - Sushil K. Mahata
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA;
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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Shahid F, Hussain A, Ul Ain N, Mehmood Bhatti M. Invasive Fungal Rhinosinusitis: Clinical and Surgical Factors Affecting Its Prognosis and Disease-Specific Morality. Cureus 2023; 15:e38830. [PMID: 37303322 PMCID: PMC10256247 DOI: 10.7759/cureus.38830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE The purpose of this study is to discover factors that determine mortality in patients with invasive fungal rhinosinusitis. METHODS This retrospective study included 17 patients diagnosed with invasive fungal rhinosinusitis and who had undergone treatment in our department, including both surgical and medical management between January 2020 and October 2020. There were four male patients and 13 female patients whose mean age was 46 ± 15.67 years, ranging from 20 to 70 years. All the patients were immune-compromised because of diabetes mellitus. We studied the factors affecting the mortality of patients affected with this disease; it included the extent of disease (paranasal sinus, palatal, orbital, or intracranial involvement), serum glucose level (SGL), and C-reactive protein (CRP) levels. RESULTS Only one patient had paranasal sinus involvement alone, but the patient became disease-free after treatment. The disease-specific mortality rate was two (33.3%) of six patients with palatal involvement and four (50%) of eight patients with intracranial involvement where four patients did not have disease control at the time of discharge and did not follow up. The death rate in orbital involvement was 20% (three of 15 patients) and five patients with intra-orbital involvement left the hospital against medical advice. The analysis of data demonstrated that only intracranial (p = 0.01) involvement in addition to the nasal cavity and paranasal sinus involvement had a statistically significant effect on survival rate unlike intra-orbital (p = 0.510) and palatal involvement (p = 0.171). CONCLUSION Early endoscopic nasal inspection, diagnosis, and treatment are critical for disease-specific mortality in invasive fungal rhinosinusitis since orbital or cerebral involvement is linked to a poor prognosis. Patients who come with uncontrolled diabetes and ophthalmological and palatal involvement with positive findings on nasal examination should necessitate urgent histopathological and radiological workup.
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Affiliation(s)
- Fatima Shahid
- Otorhinolaryngology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Asmara Hussain
- Otolaryngology, District Headquarter Hospital, Chakwal, PAK
| | - Nur Ul Ain
- Plastic and Reconstructive Surgery, Holy Family Hospital, Rawalpindi, PAK
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Ryu BU, Laylani NAR, Davila-Siliezar P, Lee AG. Rhino-orbital mucormycosis. Curr Opin Ophthalmol 2022; 33:501-506. [PMID: 36066372 DOI: 10.1097/icu.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The current article will update and review the clinical and radiological manifestations and management of rhino-orbital mucormycosis (ROM). RECENT FINDINGS There has been an increase in cases of ROM worldwide, especially in India. Immunosuppression (especially diabetes mellitus) is a known predisposing risk factor for ROM. Delayed diagnosis and treatment of ROM can be vision or life-threatening. This article reviews the clinical and radiologic features, treatment, and prognosis of ROM with special emphasis on new and emerging therapies. SUMMARY ROM is an angioinvasive fungal infection that affects the sinuses and orbits and may present to ophthalmologists. Clinicians should have a high index of suspicion for ROM, especially in patients with poorly controlled diabetes mellitus or other immunosuppression. Corticosteroid treatment (including the recent COVID-19 pandemic) may be a predisposing risk factor for ROM.
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Affiliation(s)
- Byoung U Ryu
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas
- University of Texas MD Anderson Cancer Center, Houston, Texas
- Texas A and M College of Medicine, Bryan, Texas
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Retrobulbar Amphotericin B Injection in Curbing the Progression of COVID Associated Rhino-orbital Cerebral Mucormycosis: A Retrospective Case Series. Indian J Otolaryngol Head Neck Surg 2022; 74:3352-3358. [PMID: 36246726 PMCID: PMC9547996 DOI: 10.1007/s12070-022-03199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/23/2022] [Indexed: 10/30/2022] Open
Abstract
Purpose To assess whether transcutaneous retrobulbar Amphotericin B (TRAMB) injection can halt disease progression and reduce the requirement of exenteration in post-COVID 19 Rhino-orbital cerebral Mucormycosis (ROCM)) with limited orbital disease. Methods Retrospective series from a single center included 22 patients with KOH proved post-COVID 19 ROCM with radiographic evidence of limited orbital involvement were evaluated from May 2021 to October 2021. TRAMB was given along with systemic intravenous Amphotericin B injection and sinus debridement. Demographic profile, clinical data, operative notes, blood and radiological investigations were evaluated. The primary outcome was to assess the halt in the progression of orbital disease. The primary outcome measure was to assess the halt of the disease progression and the secondary outcome was improvement in the clinical signs and symptoms. Results The mean age was 50.36 ± 9.72 years and 77.3% were men. The Stagewise distribution was twelve (54.5%) patients in stage 3a, four (18.2%) patients in stage 3b, four (18.2%) in stage 3c, one (4.5%) patient in stage 3d and one (4.5%) had stage 4 disease. Improvement in lid edema and conjunctival chemosis were noticed and it was statistically significant (p value < 0.01), similarly visual acuity and ocular motility showed significant improvements (p value 0.04 and < 0.01 respectively). 1 patient died and 1 patient required exenteration later. Twenty patients showed halting of orbital disease after TRAMB injection. Conclusion TRAMB can be an alternative adjuvant therapeutic option to preserve the globe in patients with limited orbital disease but not at all replacement for exenteration.
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Sinha S, Kumar VB, Kumar A, Singh V, Anand A, Kusumesh R, Mishra S, Raj P, Sinha BP. Outcomes of Transcutaneous Retrobulbar Amphotericin B in Rhino-Orbital-Cerebral Mucormycosis Among Patients Recovering From COVID-19: A Preliminary Experience. Cureus 2022; 14:e27817. [PMID: 36106303 PMCID: PMC9455078 DOI: 10.7759/cureus.27817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background In this study, we aimed to assess the outcomes of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in rhino-orbital-cerebral mucormycosis (ROCM) among patients recovering from coronavirus disease 2019 (COVID-19). Methodology This retrospective study was conducted at a tertiary care center in eastern India from May 29th to July 31st, 2021, and included post-COVID-19 patients admitted with stage 3 and 4a ROCM who underwent TRAMB. The details of the ophthalmic examination, laboratory investigations, and radiological examination were retrieved from patients records. Patients were given TRAMB (3.5 mg/mL) on alternate days till they underwent debulking surgery and resumed from the second postoperative day alternatively till the patients showed clinical stabilization or improvement. Results In total, 45 eyes of 41 patients were included in the study. The median number of injections given was six (minimum = 3; maximum = 10). Following was the distribution of number of injection needed in each eye: eight eyes (three injections), six eyes (four injections), seven eyes (five injections), three eyes (six injections), eight eyes (seven injections), 11 eyes (eight injections), and one eye had received nine and ten injections each. Overall, 21/32 (65.62%) eyes had improvement in proptosis whereas 9/32 (28.12%) had improvement in ptosis. Six patients had improvement in extraocular movement. In total, 25 eyes had no improvement whereas seven eyes had improvement in vision. Four eyes underwent exenteration. All nine patients with limited orbital disease had good improvement with fewer injections (median = 4). None of the patients undergoing TRAMB had an intracranial extension of disease. Moreover, 8.88% (4/45) of the eyes had post-TRAMB transient inflammation which resolved without any intervention. Finally, 3/41 of the patients died. Conclusions TRAMB can be considered as an useful therapeutic adjunct in managing ROCM. Further, it can halt the progression of the disease while awaiting definitive surgical intervention.
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Singh P, Gupta A, Sanepalli SR, Raj A. Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis. BMJ Case Rep 2022; 15:15/3/e246307. [PMID: 35361668 PMCID: PMC8971798 DOI: 10.1136/bcr-2021-246307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aim to highlight the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in cases of rhino-orbital mucormycosis. With the COVID-19 pandemic a rapid surge in the number of cases of rhino-orbital mucormycosis has been noted. The gold standard treatment for the progressive orbital disease is exenteration; however, organ salvage should be attempted, when possible. Here comes the role of TRAMB injection. We present a case of a man in his 70s, a known diabetic, who recovered from COVID-19 pneumonia but developed left-sided axial proptosis with orbital apex syndrome and ophthalmic artery occlusion secondary to rhino-orbital mucormycosis. The patient underwent debridement of paranasal sinuses and received intravenous liposomal amphotericin-B and three TRAMB injections. After three TRAMB injections significant improvement in extraocular movements, proptosis and ptosis was noted. An early intervention in orbital disease can avert a more radical procedure.
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Affiliation(s)
- Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | | | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
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Vare AA, Yellambkar S, Farheen A, Nandedkar V, Bhombe SS, Shah R. Incidence, cumulative mortality and factors affecting the outcome of COVID-19-associated mucormycosis from Western India. Indian J Ophthalmol 2021; 69:3678-3683. [PMID: 34827021 PMCID: PMC8837295 DOI: 10.4103/ijo.ijo_1767_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To report the incidence, cumulative mortality, and factors influencing the outcomes from a large series of COVID-19-associated mucormycosis (CAM) from western India. Methods Consecutive patients with CAM between March 1 and May 10, 2021, with a minimum follow-up of 1 month were included. We recorded the presence of diabetes, use of steroids, and need for non-invasive ventilation (NIV) from the case files. The features of orbital involvement, treatment administered, and outcomes, i.e., death, orbital exenteration, or recovery were noted. Cumulative probability of adverse outcomes, defined as either death or exenteration, was reported using survival analysis. Results We treated 67 cases of CAM and found an incidence of 13.6 cases per 1,000 patients post-moderate to severe COVID-19. Uncontrolled diabetes (90%) with ketoacidosis (40%) and prior systemic steroids (84%) were the strongest predispositions. The onset of CAM was 15.1 ± 9.5 days (range: 6-42 days) after recovery from COVID-19. The cumulative probability of an adverse outcome was 38% (95% confidence intervals [CI] = 23.7-56.9%) on day 20. The patients who required NIV during COVID-19 were at seven times higher risk of experiencing an adverse outcome (hazard ratios [HR] = 6.92, 95% CI = 2.9-16.2) while those who received amphotericin- -B had a 61% lower risk (HR = 0.39, 95% CI = 0.16-0.97). Conclusion The current outbreak of CAM was seen predominantly in uncontrolled diabetics, especially with ketoacidosis and steroid intake. The cumulative probability of death or orbital exenteration was 38% at day 20 of the infection and those who required NIV and did not receive amphotericin-B were at a high risk of these outcomes.
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Affiliation(s)
- Archana Ajay Vare
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Snehalata Yellambkar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Asma Farheen
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Varsha Nandedkar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Swati S Bhombe
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Rachana Shah
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
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Affiliation(s)
- Akshay Gopinathan Nair
- Department of Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, Dr. Agarwal's Group of Hospitals, Navi Mumbai, Maharashtra, India
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Hu L, Xu G. Potential Protective Role of TRPM7 and Involvement of PKC/ERK Pathway in Blue Light-Induced Apoptosis in Retinal Pigment Epithelium Cells in Vitro. Asia Pac J Ophthalmol (Phila) 2021; 10:572-578. [PMID: 34789674 PMCID: PMC8673846 DOI: 10.1097/apo.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Blue light triggers apoptosis of retinal pigment epithelium (RPE) cells and causes retinal damage. The aim of this study was to elucidate the protective role of transient receptor potential melastatin 7 (TRPM7) in photodamaged RPE cells. METHODS RPE cells were isolated from Sprague-Dawley (SD) rats and exposed to varying intensities of blue light (500-5000 lux) in vitro. Cell proliferation and metabolic activity were respectively assessed by bromodeoxyuridine (BrdU) incorporation and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays. Real-time polymerase chain reaction (RT-PCR) and western blotting were used to analyze the TRPM7, protein kinase C (PKC), extracellular signal-regulated kinase (ERK) and Bcl2-associated x/B-cell lymphoma 2 (Bax/Bcl-2) messenger RNA (mRNA) and protein expression levels. The cells were transfected with TRPM7 small interfering RNA (siRNA) or transduced with TRPM7-overexpressing lentiviruses and cultured with or without the pigment epithelium-derived factor (PEDF). RESULTS Blue light inhibited the proliferation and metabolic activity of RPE cells in an intensity-dependent manner when compared to nonirradiated controls (P < 0.05). Compared to the control, photodamaged RPE cells showed decreased levels of TRPM7, PKC, ERK, and Bax, and an increase in Bcl-2 levels (P < 0.01). Forced expression of TRPM7 partially rescued the proliferative capacity of RPE cells (P < 0.01) and restored the levels of TRPM7, PKC, ERK, and Bax (P < 0.01), whereas TRPM7 knockdown had the opposite effects (P < 0.01). TRPM7 and PEDF synergistically alleviated the damaging effects of blue light. CONCLUSIONS Blue light triggers apoptosis of RPE cells, and its deleterious effects can be partially attenuated by the synergistic action of TRPM7 and PEDF via the PKC/ERK signaling pathway.
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Affiliation(s)
- Luping Hu
- First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City 350005, China
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