RESUMO
Purpose: Known predisposing factors for mucormycosis are neutropenia and diabetes. Though COVID?19 is associated with hyperinflammatory response, a high surge in rhino?orbital?cerebral mucormycosis (ROCM) cases was observed during the second wave. The histopathological features reflect the background pathogenesis. This study analyzes the histopathological features and clinical presentation of COVID?19?associated ROCM. Methods: In this retrospective observational study, the clinical details of 89 proven ROCM patients treated during May–July 2021 were collected from the case records. Histopathological features were correlated with clinical staging groups and outcomes. The mean neutrophil?to?lymphocyte ratio (NLR) of clinical and outcome groups were compared. Results: The mean age was 54.71 ± 11.03 years, with male patients constituting a majority (78.7%). Uncontrolled diabetes mellitus was noted in 70.8% of patients, and 3.4% had normal range of blood sugar. The mean blood sugar was 298.08 ± 99.51 mg/dL. The mean duration of onset of symptoms of mucormycosis from the diagnosis of COVID?19 was 17.36 ± 7.392 (3–45) days. Poor outcome with disease progression or death occurred in 21.3% of patients. Clinical group II patients (44.9%) with ROCM stages 3c and above had poor outcomes (P = 0.005). Histopathological analysis showed minimal inflammation in 25.8%, neutrophil extracellular trap (NET) in 75.3%, and angio?invasion in 28.1% of patients. Minimal inflammation was associated with clinical group II (P = 0.004) and poor outcome (P = 0.001). Angio?invasion correlated with poor outcome (P = 0.007). Patients with severe clinical group and poor outcome had higher mean NLR with P = 0.017 and P = 0.007, respectively. Conclusion: Vision loss and cerebral involvement had poor outcomes. The histopathologic features such as inflammation and angio?invasion along with NLR aid as prognostic indicators in the management of ROCM. The role of NET in the pathogenesis of COVID?19?associated ROCM needs further studies
RESUMO
Background: Ocular surface disease is the most common, underdiagnosed comorbidity of glaucoma. Ocular surface diseaseaffects the quality of life of glaucoma patients apart from causing visual disturbances. Evaluation of ocular surface disease isimportant for complete management of glaucoma.Aims and Objectives: This study aims to evaluate the subjective and objective measures of ocular surface disease in patientswith glaucoma.Materials and Methods: A cross-sectional study was carried out on 108 eyes of 54 glaucoma patients on topical antiglaucomamedications for >6 months at the department of ophthalmology from January 2018 to January 2019. Subjective evaluation withocular surface disease index (OSDI) score and objective evaluation with tear breakup time (TBUT) and Schirmer test werecarried in all patients.Results: The subjective measure with OSDI score >12 was observed in 55.6% of glaucoma patients. The objective measures withTBUT <10 s and Schirmer test <10 mm in 5 min were observed, respectively, in 64.8% and 53.7% of glaucoma patients. Patientson longer duration (>15 months) of topical antiglaucoma medications and patients on multiple topical antiglaucoma drugs had higherOSDI score, lesser TBUT, and lesser Schirmer test values. OSDI score had strong positive correlation with TBUT and Schirmer test.Conclusion: Prompt evaluation of ocular surface disease, use of fixed-drug combinations, use of preservative-free antiglaucomaeye drops, and supplementation with lubricants will improve the compliance of patients and outcome of glaucoma management.