LAUSR

Localized form of orbit/sino-orbit invasive aspergillosis (IA) is a rare entity. Tissue sample is required for confirmatory diagnosis and initiation of treatment. Galactomannan (GM) is a heteropolysaccharide cell wall component released by growing hyphae of Aspergillus sp. GM assay is routinely done on serum for detection of systemic IA and initiation of treatment [1–4]. We conducted this study to analyze the diagnostic utility of serum GM assay in orbit/sinoorbit IA and its changes with response to voriconazole treatment. This was a prospective, observational study, conducted on biopsy proven cases of orbital and sinoorbital IA, over a study period of 18 months. Ethical clearance was obtained. Patients with mixed infection, or undergoing exenteration and/or those who were already on antifungal treatment, were excluded. GM assay was performed before initiation of treatment (day 0), on day 7, 14, and 30 of treatment using PlateliaELISA (serum GMI[ 0.5 was considered positive) [1, 2]. GMI of biopsy proven orbital diseases other than IA was considered as control values (true negative) for calculation of specificity. Detailed work up was performed. Visual acuity was noted. Severity of pain was assessed on visual analogue scale (VAS). Extraocular motility (EOM) was assessed by Kestenbaum limbus test of motility [5]. Average of EOM in all four gazes was calculated and expressed in millimeters for both eyes. Further, percentage EOM was calculated considering EOM of normal eye as 100%. Amount of proptosis was measured using Hertel exophthalmometer. Patient’s investigation reports including imaging were noted. Initial two loading doses of intravenous voriconazole, 6 mg/kg each, at 12 h interval were administered, followed by 4 mg/kg at 12 h intervals, for 2–3 weeks [6]. Thereafter, oral tablet voriconazole, 200 mg J. Navarosh N. Pushker (&) M. S. Bajaj Oculoplasty and Pediatric Ophthalmology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail: [email protected]