Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study.

BACKGROUND: To evaluate the demographic, clinical, and prognostic characteristics of patients diagnosed with COVID-19-associated mucormycosis (CAM) in Iranian patients. METHODS: This prospective observational study was conducted in 8 tertiary referral ophthalmology centers in different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination and underwent standard accepted treatment strategy based on the disease stage. RESULTS: Two hundred seventy-four CAM patients (most were males (150, 54.7%)) with a mean age of 56.8 ± 12.44 years were enrolled. Patients with a history of cigarette smoking (Adjusted Odds Ratio (AOR) = 4.36), Intensive Care Unit admission (ICU) (AOR = 16.26), higher stage of CAM (AOR = 2.72), and receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (AOR = 3.30) had higher odds of mortality. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (AOR = 0.16). Generalized Estimating Equations analysis showed that the visual acuity of deceased patients (LogMAR: 3.71, 95% CI: 3.04-4.38) was worse than that of patients who were discharged from the hospital (LogMAR: 2.42, 95% CI: 2.16-2.68) (P < 0.001). CONCLUSIONS: This study highlights significant risk factors for mortality in patients with CAM, such as cigarette smoking, ICU admission, advanced CAM stages, receiving transcutaneous retrobulbar amphotericin B and worser visual acuity. Conversely, a history of systemic corticosteroid use during COVID-19 was linked to reduced mortality. These findings underscore the critical need for early identification and targeted interventions for high-risk CAM patients to improve clinical outcomes.

Progression in pediatric glaucoma: lessons learnt from 8 years' follow-up.

Background: Surgical procedures are used as 1 of the main treatment modalities for pediatric glaucoma, even though progression may occur. In this study, we aimed to investigate the risk factors affecting the progression of pediatric glaucoma. Methods: In this retrospective cohort study, we reviewed the medical records of patients diagnosed with pediatric glaucoma between April 2009 and March 2017. Pediatric glaucoma patients who underwent regular follow-up for at least 1 year were included. Demographics, intraocular pressure (IOP), central corneal thickness (CCT), axial length (AL), cup-to-disc ratio (C/D ratio), corneal diameter, type of glaucoma, age at time of diagnosis, and age at surgery were recorded. Progression was defined as an increase in AL > 2 mm, C/D ratio > 0.2, or corneal diameter > 1 mm during 1 year of follow-up. Results: Eighty-three eyes from 46 patients were included: 37 eyes (45%) with primary congenital glaucoma (PCG), 46 eyes (55%) with secondary glaucoma, and 27 of these 83 eyes (32.5%) showed progression. Progression was comparable between eyes with PCG and secondary glaucoma (PCG, 22%; secondary glaucoma, 41%; P = 0.152). Age at the time of diagnosis and age at the time of the first surgery were significantly lower in the eyes with progression (P = 0.046 and 0.012, respectively). The mean (standard deviation) of surgeries in progressed versus non-progressed eyes was 1.88 (1.1) versus 1 (0.8) (P = 0.015). The frequency of comorbid systemic disease was significantly higher in patients with glaucoma progression (P = 0.043). The progressed and non-progressed eyes were comparable in terms of other demographic characteristics and ocular parameters (all P > 0.05). Conclusions: Pediatric glaucoma patients who were younger at the time of diagnosis and the first glaucoma surgery and those with comorbid systemic disease are at higher risk of glaucoma progression. These findings are useful for clinicians when counseling parents of children with pediatric glaucoma about disease outcomes. However, future prospective studies with larger sample sizes and longer follow-up periods are needed to confirm our findings.