Orbital Mucormycosis Research Articles

A rare case of preseptal orbital mucormycosis in a kidney transplant recipient.

A rare case of preseptal orbital mucormycosis in a kidney transplant recipient.

Prognostic factors and clinical features of rhino-orbital-mucormycosis cases: an update for patient and visual survivals.

To determine the frequency of patients' vision survival and prognostic factors and evaluate clinical features in rhino-orbital mucormycosis. Forty-three eyes of 43 patients followed up with orbital mucormycosis infections were included in the study. Demographic characteristics of the patients, symptoms at admission, ophthalmologic and non-ophthalmologic examination findings, clinical findings during follow-up, medical and surgical procedures, and complications were recorded. Patient survival was determined by assessing the incidence of mortality, and vision survival was defined as achieving a final visual acuity of at least light perception. Twenty-seven (62.8%) patients were male, and 16 (37.2%) were female. When the underlying disease status of the patients was examined, it was observed that all patients had an underlying disease and diabetes constituted the majority (65.2%). Periorbital swelling (69.8%) and ophthalmoplegia (53.5%) were the most common symptoms and findings at the admission of patients with mucormycosis infection. The disease resulted in death in 22 (51.2%) patients. The presence of fever and shorter duration of antifungal therapy were associated with lower patient survival. Exenteration surgery was not found to be associated with the survival of the patients. Frozen eye, loss of pupillary light reflex, and development of central retinal artery occlusion were associated with lower vision survival. This study presents one of the most extensive patient series in the literature on rhino-orbital mucormycosis. Knowing the patients' symptoms at the time of admission and the clinical findings during the infection process will increase awareness about the disease.

Resurgence of orbital mucormycosis during COVID-19 pandemic: Study from a tertiary care center in Eastern India.

A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens. This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge. Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%). Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..

Ocular Diseases Presenting in Post-COVID-19 Patients: A Cross-sectional Study Conducted at a Tertiary Institute in Andhra Pradesh, Southern India

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, which started in December 2019, has rapidly spread across the globe. Although the prevalence of COVID-19 disease has significantly decreased, there are cases of post-COVID-19 complications affecting multiple organ systems, including the eyes. Aim: To evaluate ocular diseases presenting in post-COVID-19 patients and their association with demographic profiles, duration of post-COVID-19, and the type of treatment received. Materials and Methods: A descriptive cross-sectional study was conducted over a four-month period (August 2021 to November 2021) in the Department of Ophthalmology at AIIMS, Mangalagiri, Guntur, Andhra Pradesh, India. The study focused on post-COVID-19 patients who had been affected by COVID-19 no more than three months prior. Patients who were not post-COVID-19 and those who had contracted COVID19 during the first wave were excluded from the study. The patients’ clinical history and symptoms were documented. Visual acuity, intraocular pressure, and detailed anterior and posterior segment findings were recorded for all patients. The study aimed to assess post-COVID-19 ocular complications and any potential associations with hospital stays, steroid intake, or oxygen inhalation on eye diseases. Mean and median calculations were performed for continuous variables, and a Chisquare test was used to study associations. Statistical Package for Social Sciences (SPSS) version 25.0 was employed, and a p-value <0.05 was deemed significant. Results: In the present study, males constituted 41 (62.1%) and females constituted 25 (37.9%), with a male-to-female ratio of 1.64:1. The majority of patients 23 (34.8%) were above 50 years old. Most patients 24 (36.4%) developed eye diseases one month after their COVID-19 infection. Out of 66 patients, 11 (16.7%) were diabetic, 8 (12.1%) were hypertensive, and 40 (60.6%) had no associated co-morbidities. During their COVID-19 illness, 53 (80.3%) patients underwent home isolation and received supportive treatment, while 13 (19.7%) patients were hospitalised. The most common ocular disease observed was conjunctivitis 39 (59.1% of patients) following post-COVID-19. Additionally, 4 (6%) patients developed central serous chorioretinopathy, 4 (6%) developed refractive errors, 5 (7.6%) experienced persistent headaches, and 2 (3%) developed orbital mucormycosis. Conclusion: The present study presents ophthalmic manifestations in post-COVID-19 patients. Conjunctivitis was found to be the most common ocular disease, more prevalent one month after the COVID-19 infection. COVID-19 retinopathy was the most common posterior segment complication, especially in patients above 50 years old and three months post-COVID-19.

Rhino orbital mucormycosis: The new mimicker of neuro-ophthalmic lesions

It was always challenging to start steroids in a suspected optic neuritis case with rhino-orbital mucormycosis being the differentials in the COVID era. A 27-year-old female presented with headache and fever for 1 week, along with sinusitis and both eyes (BE) blurred vision for 2 days. There was history of tingling sensation in both lower limbs with urinary retention previously. History of COVID infection 1 month back. Vision in Right Eye (RE): 20/20 and Left Eye (LE): counting fingers (CF) CF with presence of relative afferent pupillary defect (RAPD) Grade 3. Humphrey Visual field gave a picture of Junctional scotoma with ganglion cell loss noted in BE. Magnetic resonance imaging (MRI) brain with orbit gave a picture of LE optic neuritis with right ethmoidal, sphenoidal sinusitis involving orbital apex making mucor a suspect. MRI spine showed focal myelitis. Patient underwent nasal endoscopy to rule out rhino-orbital mucormycosis following which she was started on intravenous methylprednisolone (IVMP) and vision improved drastically. Hence, a diagnosis of neuromyelitis optica was made. Three doses of IVMP along with a tapering dose of oral prednisolone were given and the patient is still in follow-up with no recurrence reported till now.

Orbital fine needle aspiration cytology: An effective diagnostic tool for orbital mucormycocysis

Primary orbital mucormycosis is rare and challenging to diagnose. We present a case of a 52-year-old diabetic COVID-19-recovered patient in whom orbital mucormycosis was missed on a preliminary computed tomography (CT) scan. The patient deteriorated with right-sided progressive visual loss and proptosis despite treatment. CT scan was reviewed and a mild collection was found in the right orbit prompting an intraorbital fine needle aspiration cytology (FNAC) that revealed fungal hyphae consistent with mucor. Thus, right eye exenteration was performed as a lifesaving procedure. FNAC is a quick and efficient method for diagnosis of fungal infection and may be applied for confirmation of suspected orbital mucormycosis.

Prevalence, predictors, and outcome of pulmonary mucormycosis in COVID-19 associated rhino orbital mucormycosis in a tertiary care center in South India.

India witnessed an explosive rise in mucormycosis following COVID-19 infection. Pulmonary mucormycosis closely followed rhino orbital mucormycosis as the most common presentation. The need for advanced resources and lack of clinical suspicion for COVID-19-associated pulmonary mucormycosis led to widespread underdiagnosis and poor response to late therapy. The present study aimed to assess the prevalence of pulmonary mucormycosis in COVID-19-associated rhino-orbital mucormycosis using non-invasive techniques, such as sputum microscopy and chest imaging. A prospective observational study was conducted at the Institute of Internal Medicine, Rajiv Gandhi Government General Hospital in Chennai, India between June 2021 and July 2021. All hospitalized patients with proven rhino orbital mucormycosis with or without cerebral involvement within three months of confirmed COVID-19 infection who had clinical symptoms compatible with pulmonary mucormycosis were included in this study. These patients were screened for probable and possible COVID-19-associated pulmonary mucormycosis using computed tomography (CT) chest imaging and sputum microscopy within 48 h of hospital admission. Based on the findings, 8 (16%) out of 50 patients with rhino-orbital mucormycosis, had associated possible or probable pulmonary mucormycosis. All 8 patients were diabetics and had characteristic CT chest findings while only half of them had positive sputum microscopy. A higher prevalence of probably disseminated COVID-19-associated mucormycosis was noted among 51-60-year-old males with the use of corticosteroids and oxygen for COVID-19 therapy. The mortality rate was 100% in probably disseminated mucormycosis, 50% in possible disseminated mucormycosis, and only 9.5% in isolated rhino-orbital mucormycosis. Non-invasive and feasible methods, such as sputum microscopy and chest imaging can be considered for early screening and intensive management of probably disseminated mucormycosis to improve prognosis.

Turbinates involvment in rhino orbital cerebral mucormycosis in covid positive cases - A study on 100 cases

Mucormycosis also called as zygomycosis previously refers to several different diseases caused by infection with fungi belonging to the order Mucorales. Rizopus species are the most common causative organism. The infections are life threatening. Risk factors such as Diabetic Ketoacidosis and Neutropenia are present in most cases. During the pandemic period of COVID-19 2 wave rhino orbital mucormycosis was commonly effected with probable reasons are due to over dosage of steroid usage and o2 therapy, Uncontroled diabetes etc. To know the percentage of involvement of turbinates (MT,IT)in Rhino orbito cerebral mucormycosis cases in covid positive patients by doing endoscopic sinus surgery. A total of 100 covid positive patients with ROMM were selected and taken for radiological evaluation and selected for ESS during intraoperatively turbinates involvement with mucor (eschar/pus/crusting) was noted diagnosis of ROMM was based on CECT findings and symptoms in covid positive cases. Patients who are attending to Gandhi hospital during the pandemic of 2 wave of covid 19 were selected in study. Common age group with ROMM are 36to 55 years, with male predominance, commonest symptoms are unilateral facial pain & swelling, nasal crusting and dental complaints, commonest sinus to be involved is maxillary sinus, comorbid condition is Diabetes mellitus and moderate percentage of involvement of turbinates(common is middle turbinate) were noted. On microbiological and pathological examination of specimen showed positive KOH mount and mucorales order fungi are common followed by rizopus species. Main conclusions in this study are turbinates involvement with mucor in covid positive cases (eschar/necrosis/pus discharge) is more common in 43 patients (43%), most common mucor pathology seen in maxillary sinus in 58 patients(58%),followed by ethmoid sinus and sphenoid and orbit, teeth.

Sporobolomyces salmonicolor Infection in a Type 2 Diabetic Patient with a History of Rhino Orbital Mucormycosis and Stroke: A Rare Case Report from Maharashtra, India

Fungal infections are a worrisome threat to public health. We report a rare case of a 75-year-old male patient presented to the Ear, Nose, and Throat (ENT) Outpatient Department (OPD) with chief complaints of pus discharge from the left nose. The patient was already diagnosed with rhino orbital mucormycosis in July 2021. The patient had a history of stroke 1 year ago and is a known case of diabetes mellitus type 2 and systemic hypertension and is on medications. This case is extremely rare in Indian healthcare settings and can have an extensive impact on multiple organs.

Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe.

Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment.Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.

Spectrum of Fungal Infections in a Tertiary Care Centre of North India: Pre-COVID and COVID Scenario and Implications.

Background Rhino orbital mucormycosis is a rare and very aggressive entity. A sudden rise of this entity has been noticed with the insurgence of the COVID-19 pandemic both among immunocompromised and immuno-competent patients. This study was done to determine any possible correlation between these two deadly diseases. Materials and Methods This was a retrospective observational study done in the pathology department of a tertiary care center in North India over a three-year period (January 2019 - December 2021). Patient details along with relevant clinical data were retrieved from the patient's record file. Hematoxylin and eosin-stained slides of diagnosed cases were taken from the department records. Results A total of 45 patients (34 males, 11 females) were included in the study, seven of which were ophthalmic exenteration specimens. The mean age of the patients was 52.68 years. Fifteen cases showed COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) positivity. Histopathology revealed the presence of mucormycosis in all the cases. There were six cases showing granuloma formation and 14 cases revealed mixed fungal infection. Optic nerve involvement was seen in six cases of exenteration specimens. Conclusions The present study showed a sudden resurgence of secondary fungal infections, especially during the second wave of the COVID-19 pandemic. Associated co-morbid conditions and injudicious use of steroids and antibiotics have been the cause of depressed immunity leading to the infections. One must be aware of such co-infections to facilitate timely medical management to reduce morbidity and mortality.

Ophthalmic manifestations in patients recovered from COVID-19 in Mexico

Introduction and objectivesAlthough the ophthalmic manifestations appear to be associated with the coronavirus disease 2019 (COVID-19), there is not enough evidence. Hence, the aim of this study was to determine the various types and frequency of ophthalmic manifestations in patients recovered from SARS-CoV-2 infection in Mexico. Material and methodsThis retrospective, observational and descriptive study included all patients recovered from SARS-CoV-2 infection attending the tertiary level hospital of Mexican Social Security Institute (IMSS) from June 2020 to June 2022. During the hospital admission of patients, the demographic data such age, name, gender was recorded. Ophthalmologic examination was performed under torchlight by an ophthalmologist in the Department of Ophthalmology from IMSS. Data was compiled and statistically analyzed using Fisher’s exact test and Spearman correlation. ResultsA total of 3081 SARS-CoV-2-positive patients were recorded, of which 318 (10.32%) met the inclusion criteria. Of them, 21 (6.60%) had ophthalmic manifestations and the female-to-male ratio was 1.6:1. The mean age (±SD) was 47.95±15.27 years and the median (interquartile range) time from the diagnosis of COVID-19, as defined by positive SARS-CoV-2 RT-PCR testing, to detection of the ophthalmic manifestation was 31 (142) days. The most common ocular manifestation was orbital mucormycosis (23.80%). Interestingly, the presence of ophthalmic manifestations was not associated with severe COVID-19 (p=0.665). ConclusionsThe ophthalmic manifestations are infrequent in patients recovered from severe COVID-19. Nevertheless, further large sample studies are needed to confirm these findings.

Anaesthetic challenges of coronavirus disease (COVID-19) associated mucormycosis: A case series

During the second wave of COVID -19 Indian subcontinent suffered another pandemic of covid associated mucormycosis (CAM) which further burderned the already overexhausted health care infrastructure. To share our experience of anaesthetic management of eighteen patients with covid associated mucormycosis who underwent surgical resection of necrotized tissues at a tertiary care hospital of North India. : Eighteen patients with COVID-19 infection or previous history of COVID-19 infection based on RT-PCR and histopathologically proven rhino orbital mucormycosis, presented for endoscopic and open surgeries during May and June 2021. According to institutional protocol, institutional ethical committee clearance was not required for a case series. Data regarding the demographic details, clinical manifestations, COVID-19 course, laboratory parameters, imaging reports, pre-operative evaluation, airway management, intraoperative and postoperative management, and complications were collected. Out of eighteen patients 12(66.7%) were male and six (33.33%) were female, with a median age of 51 years. Six patients (33.33%) had a past history of COVID-19, twelve patients had concurrent COVID-19 (66.66%). Most of the patients presented with unilateral facial swelling, retro-orbital pain, ptosis and headache. Fifteen (83.33%) patients had high blood sugars, seven (46.66%) were known type 2 diabetics and eight (53.33%) developed new-onset diabetes after taking prolong systemic corticosteroids. All eighteen patients received antifungal treatment,eight (44.44%)patients had derranged renal function tests with raised serum creatininine (2.4-2.8) and normal blood urea nitrogen. Eight (44.44%) of them had difficult airway because of swelling on face and limited mouth opening, two patients were reoperated (n=2/18). Three (27.27%) patients deveoped arrythmias and ST changes intraoperatively, two(n=2/18) patients were extubated next day after surgery, one patient was tracheostomised in view of preoperative difficult airway and extensive surgery. One fiftyfive year old covid positive female patient died on fifth postoperative day. : In our case series, all 18 patients had covid associated rhino-orbital mucormycosis, most of them had diabetes and hypertension, cerebrovascular accident, coronary artery disease, asthma and post KTP status. Twelve patients were covid positive and 6 had recent history of covid. One patient developed hemiparesis and one patient died because of intracranial extension of mucormycosis. Disseminated or cerebral mucormycosis, severe covid, elderly age group, associated comorbidities like uncontrolled diabetes and renal failure have been found to increases mortality in CAM patients. : Physicians caring for covid associated mucormycosis patients must be aware of the severity of the covid-19 as well as mucormycosis, associated comorbidities and various side effects of the medications used for treatment. Early diagnosis and timely medical and surgical management are necessary to improve outcome in covid associated mucormycosis.

Manifestaciones oftálmicas en pacientes recuperados de COVID-19 en México

Introduction and objectivesAlthough the ophthalmic manifestations appear to be associated with the coronavirus disease 2019 (COVID-19), there is not enough evidence. Hence, the aim of this study was to determine the various types and frequency of ophthalmic manifestations in patients recovered from SARS-CoV-2 infection in Mexico. Material and methodsThis retrospective, observational and descriptive study included all patients recovered from SARS-CoV-2 infection attending the tertiary level hospital of Mexican Social Security Institute (IMSS) from June 2020 to June 2022. During the hospital admission of patients, the demographic data such age, name, gender was recorded. Ophthalmologic examination was performed under torchlight by an ophthalmologist in the Department of Ophthalmology from IMSS. Data was compiled and statistically analyzed using Fisher's exact test and Spearman correlation. ResultsA total of 3,081 SARS-CoV-2-positive patients were recorded, of which 318 (10.32%) met the inclusion criteria. Of them, 21 (6.60%) had ophthalmic manifestations and the female-to-male ratio was 1.6:1. The mean age (±SD) was 47.95±15.27 years and the median (interquartile range) time from the diagnosis of COVID-19, as defined by positive SARS-CoV-2 RT-PCR testing, to detection of the ophthalmic manifestation was 31 (142) days. The most common ocular manifestation was orbital mucormycosis (23.80%). Interestingly, the presence of ophthalmic manifestations was not associated with severe COVID-19 (p=0.665). ConclusionsThe ophthalmic manifestations are infrequent in patients recovered from severe COVID-19. Nevertheless, further large sample studies are needed to confirm these findings.

Isolated Lower Motor Neuron Facial Nerve Palsy as a Presenting Sign in COVID-19 Associated Orbital Mucormycosis Patients: A Retrospective Observational Study

Purpose: The main purpose of this study is to emphasize that isolated facial nerve involvement can be the first presenting symptom in patients suspected of COVID-associated Mucormycosis (CAM). Methods: This study is a retrospective observational study conducted at a tertiary care referral center which included patients with a history of CAM, who presented with isolated facial nerve palsy as initial presentation between March 2021 to March 2022 along with their follow-up. All the patients were managed with combined modality treatment with antifungal therapy and debridement of the necrotic tissue and fungal debris. Results: There were 184 eyes of 148 patients diagnosed with CAM. All patients developed rhino-orbital mucormycosis (ROM) following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36±23 days. 42(28%) patients presented with isolated Facial Nerve Palsy (FNP) as the initial presentation. The mean age was 48.5 years (range 38 to 67years) with a male predominance of 29 (69%). All were unilateral cases and were of Lower motor neuron type presentation. All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. At a mean follow-up of 13.1 months, 19 (45%) of the patients had improvement in Facial Nerve function and 23 (55%) had static functioning. None of them had worsened. With medical intervention and tarsorrhaphy, the corneal condition was improved in all patients. Conclusion: Isolated FNP is an unusual but important sign in the presentation of mucormycosis which can be misdiagnosed with a cerebrovascular accident leading to delay in the management. This is a large case series with isolated FNP in CAM cases. A high index of suspicion for mucormycosis in diabetic patients presenting with isolated facial palsy can save the life and salvage the eye.

Study of Clinical Profile with Radiological and Histopathological Evaluation of Patients with Orbital Mucormycosis in COVID-19 Era

Study of Clinical Profile with Radiological and Histopathological Evaluation of Patients with Orbital Mucormycosis in COVID-19 Era

Not all orbital inflammations in the COVID-19 era are due to mucormycosis – A case of orbital pseudotumour leading to vision loss

A 57-year-old male patient with type 2 diabetes mellitus who had survived severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) presented with loss of vision in the right eye (RE) of 20-day duration. The patient had been diagnosed elsewhere with orbital mucormycosis and had been treated for it. The patient developed vision loss in RE 1 week after the initiation of treatment. At the time of presentation in our institute, vision in RE had reduced to no perception of light. Examination showed a relative afferent pupillary defect and pale optic disc in RE. Gadolinium-enhanced contrast magnetic resonance imaging of the brain, orbit and paranasal sinuses suggested perineuritic type of idiopathic orbital inflammation. In the present COVID-19 scenario, diagnosis other than mucormycosis should be kept in mind when dealing with cases of orbital inflammation.

The Role of Retrobulbar Injection of Amphotericin B in the Management of Orbital Mucormycosis in a Tertiary Care Centre—Prospective Analytical Study

Aim: To study the role of retrobulbar (intraorbital) injection of amphotericin-B in the management of orbital mucormycosis. Materials and Methods: Patients with nasal diagnostic endoscopy or imaging confirmed, orbital mucormycosis were given 3 doses of 3.5 mg/ml of retrobulbar injection amphotericin-B for 3 alternate days and followed up for 72 hours for progression of symptoms. Results: Out of total 696 in-patients, 464 were males (66%) and 232 were females (34%), 612 were diabetic (88%), 490 were covid positive (71%), 308 patients have taken steroid (45%), 205 patients were given oxygen (30%). Out of 696 in-patients, 312 (45%) were started on retrobulbar injection of amphotericin. Dose wise-out of 312 retrobulbar injections, less than 3 doses is given for 69 patients (22%), 3 doses completed for 243 patients (78%). Outcomes-out of 243 three dose completed patients,49 (20%) patients has shown improvement in terms of vision and symptoms, 172 (71%) patients were stable without progression, 64 (26%) patients have shown deterioration out of which 35 patients progressed rapidly and undergone exenteration and remaining 29 are under observation. Conclusion: Retrobulbar injection of amphotericin-B along with iv amphotericin and sinus debridement through FESS have shown improvement and also halted the progression. Patients in stage 3a and 3b have shown better outcome with retrobulbar injection of amphotericin-b than in stage 3c and 3d.

Risk Factors of Rhino Orbital Mucormycosis.

To determine the clinical presentation and risk factors associated with rhino orbital mucormycosis. Mucormycosis is a rapidly progressive fungal infection caused by filamentous fungi in the Mucoraceae family. In large numbers, they release spores into the air, and humans get exposed through inhalation. The spores inoculate in the paranasal sinuses and nasopharynx and subsequently spread to the orbit and intracranial cavity. The present COVID-19 pandemic has witnessed a resurgence of rhino-orbital mucormycosis cases, mainly seen in patients with immunocompromised status. Hence, our study evaluated the risk factors and clinical features of rhino orbital mucormycosis. This was a prospective, single-center, cross-sectional study. Patients attending tertiary care centers fulfilling the inclusion criteria were evaluated with a detailed history including sociodemographic profile, occupation, history of fever, COVID-19 infection, steroid or immunosuppressant use, organ transplants, diabetes mellitus and use of oxygen (O2). A complete ophthalmic evaluation was performed, including best-corrected visual acuity, anterior segment evaluation with slit lamp biomicroscopy, and posterior segment evaluation using indirect ophthalmoscopy. Computed Tomography (CT) scan of paranasal sinuses was done for all the patients, and Magnetic Resonance Imaging (MRI) for a few patients if indicated. Intraoperatively, samples were sent for Potassium Hydroxide (KOH) stain while debridement and patients with positive results were included in the study. Forty participants were included, out of which 34 (85%) were males and six (15%) were females. The mean age of the patients was 51.75 years. Out of 40 patients, 29 (72.5%) had h/o COVID-19 infection, 30 (75%) were known type 2 diabetes mellitus, 25 (62.5%) had a h/o steroid intake and 25 (62.5%) had a history of O2 use. 17 (42.5%) patients presented with low vision, out of which 15 had no light perception. 30 (75%) patients had ptosis, 22 (55%) patients presented with proptosis, 15 (37.5%) patients had limited ocular motility, 11 (27.5%) had complete ophthalmoplegia, and 11 (27.5%) patients had central retinal artery occlusion. Rhino orbital Mucormycosis is more prevalent in patients with COVID-19 infection, especially those who have used steroids and oxygen and with type 2 diabetes mellitus. Early presentation with treatment can prevent further ocular morbidity.

A Rare Case Study to Understand the Path of Post Dengue Mucormycosis

Mucormycosis is a rare form of opportunistic and third most common fungal infection which is aggressive in nature and frequently fatal. The infection is chronic, persisting for years, attributed by immunocompromised status of the patients with poor oral and nasal hygiene. A case study attempted to understand the path of Mucormycosis in a case of post dengue infection admitted at the tertiary care hospital. Interview with the case and caretaker and the case file review was done to collect the data. This is the case of rhino- orbital Mucormycosis attributed by uncontrolled blood sugar during treatment of dengue infection, the disease progression has been triggered by ignorance from the health care personnel’s & the patient’s unhygienic practices. Unsafe and infected environment of the hospital made her immunocompromised and vulnerable due to dengue and gave the chance of disease progression.