Akshay Gopinathan Nair1,2,3,4, Namrata G Adulkar5, Lynn D'Cunha1, Priyanka R Rao1, Renuka A Bradoo6, Maneesh M Bapaye7, Abhishek Kothari8, Tarjani V Dave9, Chhaya A Shinde1. 1. Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India. 2. Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Wadala, Mumbai, India. 3. Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital & Institute, Navi Mumbai, India. 4. Oculoplastics and Orbital Surgery, R Jhunjhunwala Sankara Eye Hospital, Panvel, India. 5. Sunayan Eye Care and Aesthetic Clinic, Pune, India. 6. Department of Otorhinolaryngology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India. 7. Bapaye Eye Hospital, Nashik, India. 8. Pink City Eye & Retina Centre, Jaipur, India. 9. Ophthalmic Plastic Surgery and Ocular Oncology Services, L V Prasad Eye Institute, Hyderabad, India.
Abstract
PURPOSE: To report a series of 13 immunocompetent patients who developed new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection and presented as rhino-orbital mucormycosis (ROM). METHOD: Retrospective study. RESULTS: A total of 127 patients of COVID-19 Associated Mucormycosis (CAM) were evaluated at four centres in India. All patients underwent endoscopic sinus debridement surgery and received systemic amphotericin-B therapy. Five patients (5/13; 38.4%) received retrobulbar amphotericin-B injections. Orbital exenteration was performed in advanced orbital involvement or progression of orbital disease in spite of maximal medical therapy. In his cohort, 13/127 (10.2%) patients presented with new onset DM, where one patient had bilateral disease. The mean age was 35.9 years (range: 20-51 years) and the mean duration from diagnosis of COVID-19 to the diagnosis of mucormycosis was 14.2 days. While 7/13 (53.8%) of the patients received systemic corticosteroids during the course of their treatment for COVID-19, six patients received no steroids or immunomodulators. The mean follow-up period was 9.2 weeks (range: 3-18 weeks) following discharge. Life salvage was possible in 100% of the cases. While overall globe salvage was possible in 42.8% (6/14 eyes), the globe could be preserved in 4/5 patients who received retrobulbar amphotericin-B injections. CONCLUSIONS: Those involved in the care of COVID-19 patients should be aware about the possibility of recent-onset DM, even in patients without a history of corticosteroid therapy. Rarely, recent-onset DM following COVID-19 may present as rhino-orbital mucormycosis, which requires aggressive surgical and medical intervention.
PURPOSE: To report a series of 13 immunocompetent patients who developed new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection and presented as rhino-orbital mucormycosis (ROM). METHOD: Retrospective study. RESULTS: A total of 127 patients of COVID-19 Associated Mucormycosis (CAM) were evaluated at four centres in India. All patients underwent endoscopic sinus debridement surgery and received systemic amphotericin-B therapy. Five patients (5/13; 38.4%) received retrobulbar amphotericin-B injections. Orbital exenteration was performed in advanced orbital involvement or progression of orbital disease in spite of maximal medical therapy. In his cohort, 13/127 (10.2%) patients presented with new onset DM, where one patient had bilateral disease. The mean age was 35.9 years (range: 20-51 years) and the mean duration from diagnosis of COVID-19 to the diagnosis of mucormycosis was 14.2 days. While 7/13 (53.8%) of the patients received systemic corticosteroids during the course of their treatment for COVID-19, six patients received no steroids or immunomodulators. The mean follow-up period was 9.2 weeks (range: 3-18 weeks) following discharge. Life salvage was possible in 100% of the cases. While overall globe salvage was possible in 42.8% (6/14 eyes), the globe could be preserved in 4/5 patients who received retrobulbar amphotericin-B injections. CONCLUSIONS: Those involved in the care of COVID-19 patients should be aware about the possibility of recent-onset DM, even in patients without a history of corticosteroid therapy. Rarely, recent-onset DM following COVID-19 may present as rhino-orbital mucormycosis, which requires aggressive surgical and medical intervention.
Authors: Timothy P H Lin; Chung-Nga Ko; Ke Zheng; Kenny H W Lai; Raymond L M Wong; Allie Lee; Shaochong Zhang; Suber S Huang; Kelvin H Wan; Dennis S C Lam Journal: Asia Pac J Ophthalmol (Phila) Date: 2021-11-24