- Survival rate without surgical debridement and medical treatment believed to be 25% (Arch Ophthalmol 2007; 125:848)
- Survival rate with current surgical and medical treatment is about 85% (Arch Ophthalmol 2007; 125:848).
- Survival depends on depth of disease penetration on presentation and clinical recognition.
- Antifungal medications include the polyenes (amphotericin B deoxycholate), the triazoles (fluconazole, voriconazole), and the echinocandins (caspofungin, micafungin, anidulafungin).
- Liposomal form of amphotericin B lowers systemic toxicity.
- Catheter infusion into affected sinus or area of debridement
- Voriconazole might be preferred as first-line therapy (Mycoses 2012; 55:352).
- Voriconazole has the advantage of initiation with intravenous and conversion to oral therapy.
- In cases of primary treatment failure, alternative antifungal therapy (Am J Ophthalmol 2006; 142:187) includes oral posaconazole (Arch Ophthalmol 2007; 125:848).
- Posaconazole is a triazole antifungal agent used as adjuvant or salvage therapy for the treatment of zygomycosis (Pharmcotherapy J Hum Pharmacol Drug Ther 2013; 33:e1).
- Induction antifungal therapy may require three months of treatment (Muggeo, 2019).
- Maintenance antifungal therapy may be continued for more than 12 months.
- Oral posaconazole or isavuconazole may be appropriate for maintenance therapy.
- Hyperbaric oxygen can improve regional host defenses, preserve tissue, and decrease regional acidosis (Am J Ophthalmol 1992; 114:208).
- Wide local excision and surgical debridement of all devitalized and necrotic tissue including mouth, nose, sinus, and orbit
- Frozen-section histopathology can guide debridement by defining affected and devitalized tissue (Am J Ophthalmol 1997; 124:265).
- Indications for exenteration in mucormycosis were evaluated by literature review of 113 articles (1943-2004) (OPRS 2006; 22:286).
- The authors failed to define an evidence-based standard on when patients would benefit from exenteration.
Other management considerations
- Correction of diabetic ketoacidosis and other metabolic abnormalities
- Wound care can include irrigation with antifungal agents via catheter.
Common treatment responses, follow-up strategies
Prolonged oral therapy, up to 6 months, might be indicated.