Survival benefit of exenteration in COVID-19-associated rhino-orbital mucormycosis.

PURPOSE: There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS: The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS: A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION: The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India.

Purpose: To report the clinico-demographic profile of rhino-orbito-cerebral mucormycosis (ROCM) in patients during the "second wave" of the COVID-19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross-sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID-19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID-19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty-six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID-19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Role of Single Dose of Intravitreal Recombinant Tissue Plasminogen Activator in Vitreomacular Traction and Associated Macular Edema: a Retrospective Study.

Introduction: To evaluate the role of single dose of intravitreal recombinant tissue plasminogen activator (RTPA) in patients with vitreomacular traction (VMT) and macular edema. Methodology: Eighteen eyes of 18 patients with VMT and macular edema, as evidenced by spectral domain optical coherence tomography (SD-OCT), were selected in our Malda Medical College. After proper history taking and required systemic examinations, each patient underwent detailed ophthalmic examination, including best corrected visual acuity (BCVA), intraocular pressure, slit lamp examination, fundal evaluation by indirect ophthalmoscopy, 78D, 90D lens. All patients underwent SD-OCT examination to evaluate central macular thickness (CMT). Then, after proper informed consent, intravitreal injections with 50 micrograms of RTPA were administered to each patient and all baseline examinations were repeated one month and three months after injection. Results:Postoperatively, 16 patients had complete posterior vitreous detachment (PVD) and 14 resolution of VMT. All participants showed an improvement in BCVA and reduction in CMT. Conclusion:Intravitreal RTPA might be a useful agent in resolution of VMT associated with macular edema.

Role of Combined Therapy of Intravitreal Ranibizumab and Dexamethasone in Refractory Diabetic Macular Edema: a Retrospective Study.

Aim: To evaluate the role of intravitreal Ranibizumab injection at monthly interval for six doses along with single dose of intravitreal dexamethasone implant at first sitting of Ranibizumab in patients with refractory diabetic macular edema (DME). Methodology: Thirty eyes of 30 patients were selected in our Malda medical college with refractory DME. After proper history taking and required systemic examinations, each patient underwent detailed ophthalmic examination, including best corrected visual acuity (BCVA), intraocular pressure measurement, slit lamp examination, fundal evaluation by indirect ophthalmoscopy, 78D, 90D lens. Spectral domain optical coherence tomography (SD-OCT) has been used to evaluate central macular thickness (CMT) in each patient. After proper informed consent, 0.05 mg Ranibizumab along with 0.7 mg dexamethasone implant were injected intravitreally in each patient at first sitting, followed by intravitreal Ranibizumab for five more doses at one month interval, and all baseline investigations were repeated at one month after the first sitting as well as one month after the last dose of intravitreal Ranibizumab. Results:Postoperatively, 21 patients out of 30 had shown encouraging results as far as both improvement in BCVA and reduction in central macular thickness (CMT) were concerned. Conclusion:Intravitreal Ranibizumab combined with intravitreal dexamethasone implant might be a useful tool to deal with refractory diabetic macular edema (DME).

Ultrastructural, Histochemical, Cytological Study of Retina of Aborted Fetus of Various Weeks of Gestation - an Anatomical Perspective with Implications on Patients with Retinitis Pigmentosa.

Aim: To study the ultrastructural, histochemical, cytological features of retina in aborted fetuses of different gestational age and its probable implication in the disease process of retinitis pigmentosa. Methodology: This is a prospective randomized cross sectional study that has been carried out in AIIMS Bhubaneswar from June 2017 to May 2019, jointly by the Department of Anatomy and Obstetrics and Gynaecology, AIIMS, Bhubaneswar, India, after proper institutional approval. Three fetuses from each trimester were taken into the present study; their retina was collected and subsequently sent for cytological, immunohistochemical and ultrastructural explorations. Detailed information from all explorations were collected and properly documented. Results:Fetuses whose retinas that have been shown to contain very few to no rod cells and short-sized cone cells might tend to develop retinitis pigmentosa after birth. Moreover, those cone cells have been shown to contain melanolysosome, phagosomes, autophagic vacuoles, and membranous whorls.

Ocular rhinosporidiosis presenting as recurrent chalazion.

Rhinosporidiosis, a granulomatous disease caused by Rhinosporidium seeberi, is widely prevalent in Sri Lanka and southern parts of India. Besides the eye, the lacrimal passage and nasal cavity are affected. The most common ocular involvement is a subconjunctival bleeding mass. Our case, a 9-year-old girl from a rural background with a history of pond water bathing, presented with a marginal chalazion involving the left lower lid. She had a history of chalazion involving the same site three months earlier which was managed by incision and curettage. A decision of surgical exploration was made and the evacuated mass was examined histologically showing evidence of rhinosporidiosis. This type of clinical presentation for ocular rhinosporidiosis (as recurrent chalazion) has not been reported earlier in the literature. This case emphasises that the clinicians from this part of the world must consider ocular rhinosporidiosis as differential diagnosis in cases with recurrent chalazion especially in a rural background with a habit of pond water bathing.