Ophthalmic presentation and outcomes of rhino-orbito-cerebral mucormycosis during the COVID-19 pandemic: An 18-month follow-up report

A Veisi; M Aletaha; M Abolhosseini; V Ownagh; S Fekri; M Feizi; S Amoushahi Khouzani; M Najafi

doi:10.1016/j.jfo.2024.104139

Ophthalmic presentation and outcomes of rhino-orbito-cerebral mucormycosis during the COVID-19 pandemic: An 18-month follow-up report

J Fr Ophtalmol. 2024 Mar 8;47(5):104139. doi: 10.1016/j.jfo.2024.104139. Online ahead of print.

Authors

A Veisi¹, M Aletaha¹, M Abolhosseini², V Ownagh³, S Fekri⁴, M Feizi², S Amoushahi Khouzani⁴, M Najafi⁵

Affiliations

¹ Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA.
⁴ Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: najafi.mary@gmail.com.

PMID: 38696866
DOI: 10.1016/j.jfo.2024.104139

Abstract

Purpose: To investigate the long-term outcomes of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM) patients.

Methods: Retrospective, observational study including all COVID-19 patients who developed ROCM and were referred to our oculoplastic clinic.

Results: Twenty-one patients with COVID-19-associated ROCM were included in this study. Twelve (57.1%) individuals were female with a mean age of 50.7±7.6 years (range 33-59), and nine (38.1%) were male with a mean age of 58.7±14.4 years (range 37-82). Corticosteroids were used in 85.7% of patients, and three patients received no systemic corticosteroids; 76.2% were diabetic and two of these developed new-onset diabetes mellitus (DM) after receiving corticosteroids during their treatment course. The average interval between COVID-19 and the development of ROCM in our subjects was 18.6 days (range 8-46 days). In our series of patients, decreasing vision, proptosis, and periorbital edema constituted the most prevalent presentation, seen in 52.4% of subjects. Endoscopic paranasal sinus debridement was performed a mean of 3.4 times in 95.2%, abscess drainage in one, and orbital exenteration in three (14.2%) patients. Orbital apex and bilateral paranasal sinus involvement were significantly associated with higher mortality, and the overall 18-month survival rate was 52.3%.

Conclusion: Based upon common factors among the COVID-19-associated ROCM patients, we presume that DM and drug-induced immunosuppression are two main factors, which may lead to a higher rate of ROCM infection in areas where fungal spores are more likely to be present, such as hospitals.

Keywords: COVID-19; Exentération orbitaire; Mucormycose rhino-orbito-cérébrale; Orbital exenteration; Rhino-orbito-cerebral mucormycosis.