ABSTRACT
Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment. Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.
ABSTRACT
PURPOSE: To evaluate intraocular pressure (IOP) control, visual prognosis, and complications following phacoemulsification in eyes with phacomorphic angle closure of <10 days' duration. METHODS: Prospective, nonrandomized interventional consecutive case series included all patients with phacomorphic glaucoma who presented between November 2020 and November 2021. All patients underwent slit-lamp biomicroscopy, applanation tonometry, and gonioscopy of the other eye. Phacoemulsification with IOL implantation under topical anesthesia was performed in all cases. A complete ophthalmic examination was done at each follow-up visit. RESULTS: A total of 50 eyes with phacomorphic glaucoma were included in this study. The preoperative mean IOP was 41.12 ± 8.20 mmHg and the mean IOP at last visit was 13.84 ± 2.08 mmHg. There was a statistically significant difference between IOP at presentation and IOP at last follow-up (P < 0.001) (Wilcoxon Signed-Ranks Test). There was no requirement of long-term anti-glaucoma medications in any patients. No significant intraoperative complications were noted. The final postoperative best-corrected visual acuity was 6/12 or better in 32 patients. Sixteen eyes had corneal edema and 20 eyes had anterior chamber inflammation on postoperative day one that resolved with standard medical therapy. CONCLUSION: Phacoemulsification is safe and effective in controlling IOP and achieving good functional visual acuity with minimal complications in the management of phacomorphic glaucoma in expert hands. Our study also lays emphasis on public awareness, early detection, and management of advanced cataract, so that the incidence of this potentially blinding entity can be reduced.
