Varshitha Hemanth Vasanthapuram1, Roshmi Gupta1, Namrata Adulkar2, Akshay Gopinathan Nair3,4,5, Renuka A Bradoo6, Raghuraj Hegde7, Usha Singh8, Sameeksha Tadepalli8, Bipasha Mukherjee9, Saurabh Kamal10, Md Shahid Alam11, Raksha Rao1, Sushma Ananthakrishna1, Varsha Backiavathy9, Ajay Krishna Murthy1, Lynn D'Cunha5, Gagan Dudeja1, Annie Joji1, Anjali Kiran1, Kirti Koka9, Moupia Goswami Mukhopadhyay1, Sonam Poonam Nisar9, Priyanka R Rao5, Chhaya A Shinde5. 1. Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India. 2. Orbit & Oculoplasty Services, Sunayan Eye Care and Aesthetic Clinic, Pune, India. 3. Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India. 4. Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital & institute, Advanced Eye Hospital & Institute, Navi Mumbai India. 5. Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. 6. Department of ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. 7. Orbit, Ophthalmic Plastic Surgery & Ophthalmic Oncology Service, Department of Ophthalmology, Manipal Hospital, Bangalore, India. 8. Department of Ophthalmic Plastic Surgery, Advanced Eye Centre, PGIMER, Chandigarh, India. 9. Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India. 10. Orbit & Oculoplasty Services, EYEHUB, Faridabad, India. 11. Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, India.
Abstract
PURPOSE: To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. METHODS: Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed. RESULTS: There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years (p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 (p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect (p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease. CONCLUSION: Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.
PURPOSE: To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. METHODS: Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed. RESULTS: There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years (p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 (p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect (p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease. CONCLUSION: Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.