RETROSPECTIVE ANALYSIS OF FUNDUS CHANGES IN POST COVID RHINO ORBITAL CEREBRAL MUCORMYCOSIS - A CASE SERIES

Abstract

Aim:To study the fundus changes in post COVID- Rhino-orbital-cerebral mucormycosis. Methods: The study was done by collecting data from 30 cases of ROCM admitted in GGH, Kurnool. Detailed history was taken along with systemic ,ENT, ophthalmic and neurological examination and all necessary investigations were done including contrast enhanced MRI. Treatment was started with systemic and retrobulbar amphotericin-B injections. Fundus pictures were taken. Results: All of them had history of infection with covid-19 dated about 3-5 weeks back. Among them 18 had corticosteroid administration, 12 had oxygen with nasal prongs/mask, 2 had high flow/non-invasive ventilation. All of them were diabetics and 21 were hypertensives.Most of them had orbital/facial pain & edema, headache, 24 patients had proptosis, 16 had ptosis, 20 had ocular movement restriction,18 had loss of vision. In Contrast Enhanced MRI scan, 28 cases showed diffuse PNS involvement,4 had medial orbital involvement, 8 had diffuse orbital involvement,18 had involvement of orbital apex, 6 had CNS involvement. Fundus examination revealed optic atrophy in 15 cases, 5 had CRAO and 3 had CRVO,8 had diabetic retinopathy,4 had hypertensive retinopathy, others had no significant abnormality. Conclusion: Mucormycosis is a rapidly progressive angioinvasive fungal infection which has been on rise in India with the 2nd wave of COVID-19. Early diagnosis and management are essential to halt the spread of infection and prevent diminution of vision and therefore, further improve the visual outcome and overall prognosis of the patient.