COVID 19 Associated Rhino-Orbital-Cerebral Mucormycosis- Clinicoetiological Profile and Management Outcome of Patients in Tertiary Eye Care Centre in Northern India

Abstract

Purpose: To analyse demographic data, clinical presentation, intervention and management of Post COVID 19 Rhino- orbito-cerebral- mucormycosis (ROCM) thus improving the knowledge about the disease to provide timely and optimal care for favorable outcome. Method: A retrospective interventional study was conducted on 254 patients admitted in Mucor ward over a duration of 2 months (1st May 2021- 30th June 2021). Demographic data, detailed history, clinical parameters, diagnostic procedures, management and outcome were noted. Factors affecting outcome and mortality were analysed. Results: Mean age of presentation was 50.14 ±13.38 years with male preponderance (64.56%). 55.91% patients presented with ROCM symptoms within 14 days of onset of COVID -19 symptoms. 86% patients were diabetics, 76% had history of corticosteroid use and 27.55% received oxygen therapy. 40 % patients presented with orbital edema as primary symptom. Imaging revealed 28.34% patients had disease limited to the paranasal sinuses (PNS), 56.69% had orbit and PNS involvement and 12.99% had PNS, orbit and CNS involvement. All the patients were treated with Liposomal Amphotericin B and sinus debridement. Eighteen eyes underwent (7.08%) exenteration and 82 patients received Transcutaneous retrobulbar Amphotericin-B. At the time of discharge the final outcome of being alive and having stable disease was found to be significant in stage 2 patients with involvement of PNS and orbit. Conclusion: Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with Amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

Outcomes of Transcutaneous Retrobulbar Amphotericin B in Rhino-Orbital-Cerebral Mucormycosis Among Patients Recovering From COVID-19: A Preliminary Experience

“…Studies have reported a male preponderance ranging from 64.56-76% while we report a 58.5% male preponderance in our study [7,[9][10][11]. The mean age of patients was 46 ± 2 years, and the median was 50 years (32-73 years), which is similar to that reported in the literature [7,[11][12][13][14][15].…”

“…Similarly, studies have reported DM in 74-100% of the patients with mucormycosis [2,9,17,18]. In our study, 90.24% (37/41) of the patients were diabetic, of whom 24 (64.86%) were recently diagnosed with diabetes post-COVID-19 infection.…”

“…In our study 26% of the patients presented with PL-negative vision, and 21.21% of the patients had improvement in vision. Visual improvement has been reported to be 3.57-7.31% in various studies [7,9]. It has been postulated that improved orbital disease control caused by retrobulbar treatment preserves perfusion to the optic nerve and leads to better visual outcomes [6].…”