Analysis of ophthalmic manifestations of invasive rhino-orbito-cerebral mucormycosis in COVID-19 patients in a medical college

Abstract

To analyze different ophthalmic manifestations of rhino-orbital mucormycosis (ROM) infection in COVID-19 patients. Prospective interventional clinical study.20 microbiologically confirmed ROCM cases with ophthalmic involvement hospitalized between May 2021 and July 2021 in our center were included in this study. Among 20 cases there were 9 female and 11 male with a mean age of 57.5 years. All 20 patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 3.67 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 3.46 days. 4 patients (20%) had orbital apex syndrome, and 16 patients (80%) presented with orbital cellulitis. CT scan/MRI revealed sino-orbital involvement in all patients, and 3 of these had cerebral involvement at initial presentation. All 20 patients received intravenous amphotericin B and 7 patients received TRAMB and all 20 patients had undergone radical debridement of involved sinuses. Despite all measures, 3 (7.5%) of 20 patients with cerebral dissemination expired. Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. An aggressive multidisciplinary approach can help to reduce mortality.