Objective: To determine if there was an increase in the rate of cases presenting with rhino-orbital-cerebral mucormycosis (ROCM) to a tertiary care center during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and the characteristics of the presenting cases.Methods: Retrospective observational study reviewing ROCM cases presenting from March 25 until September 25, 2020. Cases fulfilling the clinical, radiological, and pathological/microbiological criteria for diagnosis with ROCM were included. The number of cases presenting during the designated interval, their COVID-19 status, comorbidities, and clinical presentation were analyzed. The number of cases during the corresponding interval in the previous 3 years was used as reference to detect if there was a recent spike.Results: Of the 12 ROCM cases identified, 5 had a concurrent positive reverse transcription PCR (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 had a prior positive result, and 6 did not have concurrent nor prior positive test results. Nine of the 12 cases had poorly controlled diabetes mellitus, and 2 cases had a hematological malignancy. All cases had orbital invasion, and eight cases had cerebral invasion. The number of cases identified during the interval is much higher than the numbers presenting in the prior 3 years during equivalent intervals (range, one to two cases) than those reported in the literature in different settings in the pre-pandemic era.Conclusions: There is an increased rate of ROCM cases presenting to our center during the first wave of the COVID-19 pandemic. This is a preliminary report, and further studies are needed to corroborate the findings and explain possible underlying links.

Background: The incidence of devastating opportunistic coinfections in patients with COVID-19 infection, their imaging features and their morbidity and mortality consequences need to be unraveled. Methods: This is a case series presenting the radiologic features and clinical presentation of acute invasive fungal rhino-orbital-cerebral sinusitis (AIFS) in eight hospitalized patients with confirmed COVID-19 infection. Results: Our patient cohort presented with symptoms of the invasive fungal disease within 12-35 days from their initial presentation with COVID-19 infection. The cross-sectional imaging features of AIFS associated with COVID-19 infection do not differ from those reported in the literature for AIFS associated with other risk factors, yet our patients had features of aggressive late-stage forms with high morbidity and mortality rate. Conclusion: AIFS is a possible encounter in patients with COVID-19 patients and radiologists should be familiar with its imaging features.

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Background To evaluate choroidal thickness (CT) in diabetic patients without diabetic retinopathy (DR) in relation to the urinary albumin excretion rate (UAER). Methods This is a prospective case-control study that included a consecutive sample of 120 patients with type 2 diabetes without clinically evident DR and a group of 60 matched healthy controls. Diabetic patients were included in two groups according to their UAER (normoalbuminuria and microalbuminuria). Complete ophthalmological examination was performed followed by optical coherence tomography (SD-OCT) for retinal and choroidal assessment. Twenty-four-hour urine samples were collected for UAER and blood samples for HbA1c and serum creatinine were obtained. Results The study included 180 eyes from 180 subjects in three groups. Patients with higher levels of albuminuria had a thinner choroid than normal controls, with decremental thinning as albuminuria progressed. Diabetics with normoalbuminuria showed no significant differences from controls. Choroidal thickness showed a significant moderate negative correlation with UAER (r  =  − 0.58, p  <  0.001). Multiple regression analyses for diabetic patients with microalbuminuria demonstrated that UAER is the most important determinant of subfoveal choroidal thickness (SFCT) (p  <  0.001). Conclusions Decreased CT was significantly correlated with UAER in diabetic patients without retinopathy and otherwise normal kidney functions. This decrease in thickness might be a predictor of DR.

Background Sickle cell disease is known to cause vaso-occlusive peripheral retinopathy as a result of the microvascular insults that occur when sickled erythrocytes affect the retinal and choroidal blood flow. This leads to non-proliferative retinopathy (NPR) and proliferative retinopathy (PR) that can result in vision affection. While sickle cell retinopathy (SCR) in adult patients is well described, less is known about the retinal changes that occur in pediatric patients. To date, most studies have been of adults. Objective To screen children with sickle cell disease for the presence of retinal and choroidal changes and to compare the findings with age and sex matched controls by performing structural SD-OCT and OCTA and to correlate between findings. This aimed to assess the prevalence and age of onset of retinopathy among pediatric patients. Patients and Methods This cross sectional study was carried out from February 2020 to August 2020 on 30 eyes of patients attending outpatient clinic of Ophthalmology and Pediatric Departments of Ain Shams University Hospitals. Those patients were asked to participate and were enrolled in this study. The ethical standards stated by the ethical committee of Ain Shams University Hospitals were followed. Informed written consent was taken from guardians of all participants. Results There was a significant difference between the cases and control groups regarding the SCP and DCP vessel density, FAZ area, vascular disc density, central macular thickness, choroidal thickness, RNFL average thickness, IS/OS and C/D vertical ratio. However, there was no significant difference between the cases two groups regarding the GCC. There was a significant positive correlation between the retinal thickness and the vessel density in the SCP and DCP in the corresponding subfields. There was a positive statistically significant correlation between the Hb F level and the vessel density of the SCP and DCP. Also, there was a negative statistically significant correlation between the Hb F level and the FAZ. There was a negative statistically significant correlation between the Hb S level and the choroidal thickness, GCC and RNFL average thickness. There was also a statistically significant negative correlation between the disease duration and the temporal parafoveal retinal thickness. Conclusion SD-OCT and OCTA were able to detect areas of thinning and decreased vascular densities in asymptomatic sickle cell children. This study demonstrated a decreased vessel density on OCTA but a normal retinal thickness on SD-OCT in some of the parafoveal sucfields. This suggests that OCTA can detect microvascular abnormalities and retinopathy early even before it is visible on OCT. Further longitudinal studies are needed to examine the vascular densities and retinal and choroidal thinning in sickle cell disease children and their correlation with the various disease parameters.