Decoding Acute Invasive Fungal Rhino-Orbital Sinusitis

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About the Guests:

M. Reza Vagefi, M.D.

Dr. Reza Vagefi is a renowned oculofacial plastic surgeon based in Boston at Tufts University School of Medicine. He is recognized for his contributions to the treatment of orbital tumors and infections and has a particular interest in the management of acute invasive fungal rhino-orbital sinusitis.

Daniel Rootman, M.D.

Dr. Daniel Rootman is an accomplished orbital surgeon based in Los Angeles, California, at UCLA. He has significantly contributed to the field through his research, focusing on complex orbital diseases and their management. Dr. Rootman is also an advocate for evidence-based, minimally invasive treatments.

Tarjani Dave, M.D.

Dr. Tarjani Dave is a noted oculofacial surgeon from Hyderabad, India, working at the LV Prasad Eye Institute. She has gained worldwide recognition for her work on mucormycosis, especially during the Covid-19 pandemic, where her research and clinical efforts have made substantial impacts on disease management.

Episode Summary:

Welcome to the Oculofacial Podcast hosted by Dr. M. Reza Vagefi. In this insightful episode, Dr. Vagefi is joined by Dr. Daniel Rootman from UCLA and Dr. Tarjani Dave from the LV Prasad Eye Institute to discuss the complexities of acute invasive fungal rhino orbital sinusitis, particularly in the context of the Covid-19 pandemic. This episode dives deep into the debates and evolving treatment paradigms surrounding the disease, with the guests sharing their firsthand experiences and clinical insights.

The discussion starts with an exploration of the controversial topic of exenteration in treating mucormycosis. With differing viewpoints, the guests debate whether this aggressive surgical approach is justifiable or if minimally invasive procedures offer equally effective outcomes. Utilizing SEO-focused keywords, Dr. Vagefi and his guests emphasize the importance of MRI imaging in the diagnosis of orbital fungal infections and the clinical decision-making process. They also discuss the significant surge in mucormycosis cases observed in India during the Covid-19 pandemic, sharing personal experiences and clinical strategies that were developed in response to this crisis.

Key Takeaways:

• Role of Exenteration: The efficacy and necessity of exenteration in treating mucormycosis are debated, with a shift towards less invasive methods discussed.

• Imaging Importance: Emphasis on the use of MRI over CT scans for the diagnosis of orbital fungal infections, highlighting MRI’s superior sensitivity.

• Covid-19 Pandemic Impact: Insightful discussion on the surge of mucormycosis cases during the Covid-19 pandemic in India and the treatment strategies adapted.

• Retrobulbar Amphotericin Injections: Exploration of the role and efficacy of retrobulbar amphotericin B injections in sparing ocular structures and preserving the orbital tissues.

• Research Directions: Future research needs, including drug sensitivity, diagnostic techniques, and the impact of systemic advancements in antifungal therapies.