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

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.

Clinical Manifestations of Orbital Involvement in IgG4-Related Disease: A Retrospective Study of 573 Patients

Purpose: To investigate the clinical manifestations of orbital involvement in a large cohort of Chinese patients with IgG4-related disease (IgG4-RD). Methods: A total of 573 patients with IgG4-related disease were included. We described and compared the demographic, clinical, laboratory and histopathologic findings from 314 patients with IgG4-related ophthalmic disease (IgG4-ROD) and 259 with extra-ophthalmic IgG4-RD.Results: Male predominance was found significant in extra-ophthalmic IgG4-RD only. Patients with IgG4-ROD showed younger age at diagnosis and longer duration from onset till diagnosis. In patients with extra-ophthalmic IgG4-RD, the most commonly involved extra-ophthalmic organ was pancreas; while in IgG4-ROD patients, salivary gland was most frequently affected. Multivariate analysis exhibited IgG4-ROD was associated with allergy history, higher serum IgG4/IgG ratio, multiple organs involvement and sialoadenitis. Orbital images were reviewed in 173 (55.1%) IgG4-ROD patients. Fifty-one (29.5%) patients had multiple lesions. Lacrimal gland involvement was detected in 151 (87.3%) patients, followed by extraocular muscles (40, 23.1%), other orbital soft tissue (40, 23.1%) and trigeminal nerve (8, 4.6%). Biopsy was performed from various organs in 390 cases. A dense lymphoplasmacytic infiltration and fibrosis were the main feature in orbital specimens. Storiform fibrosis and obliterative phlebitis were absent in lacrimal gland.Conclusions: Lacrimal gland involvement was the most common orbital manifestation of IgG4-ROD. Patients with IgG4-ROD showed different characteristic in demographic, clinical, laboratory findings compared to patients with extra-ophthalmic IgG4-RD. These features might indicate potential differences in the pathogenesis of these two subgroups of IgG4-RD.

Acute Invasive Fungal Rhinosinusitis-Related Orbital Infection: A Single Medical Center Experience

Backgrounds. Acute invasive fungal rhinosinusitis (AIFRS) is a hazardous infectious disease with rapid progression and high mortality and morbidities. Further orbital involvement is commonly seen. This study aims to analyze risk factors, clinical characteristics, and outcomes between patients with or without orbital involvement. Methods. A retrospective review was performed in a single tertiary medical center over a span of 13 years (2005–2018). A total of 21 patients with diagnosis of AIFRS were enrolled. We reviewed the patients’ basic characteristics, comorbidities, clinical presentations, image study findings, culture pathogens, and treatment outcomes and analyzed the differences between orbital-involved and orbital sparing disease. Results. The most common comorbidities in AIFRS were diabetes mellitus (DM) and hematological malignancy. Nine the 21 AIFRS patients had orbital-involved disease. Patients with orbital involvement had a higher prevalence of DM ( p < 0.05 ). Image studies revealed significant infection of the ethmoid sinus, sphenoid sinus, and frontal sinus in the group with orbital complication ( p < 0.05 ). Mucor, Rhizopus, and Aspergillus were cultured in both groups. Five patients in the orbital involvement group expired, with all of them having an initial presentation of conscious disturbance ( p < 0.01 ). Rhino-orbital-cerebral fungal infection was noticed in 3 of the 5 expired patients. Conclusion. In AIFRS patients, DM other than hematological malignancy was the main risk factor for orbital-involved disease. Patients with ethmoid, sphenoid, or frontal sinusitis had a higher possibility of orbital complication. Poor consciousness at initial presentation revealed highest possibility of rhino-orbital-cerebral fungal infection and led to death.