Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome.

PURPOSE: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM. METHODS: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome. RESULTS: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009). CONCLUSIONS: The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.

Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India.

Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription-polymerase chain reaction (RT-PCR) to screen COVID-19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital-based study. Point-of-care (PoC) RAT was performed using nasopharyngeal swab, while RT-PCR for SARS-CoV-2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS-CoV-2 by using both RAT and RT-PCR. Only one patient had tested positive for SARS-CoV-2 with both RAT and RT-PCR, while two patients had tested positive with RT-PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT-PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen's kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT-PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen's kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT-PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID-19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.

Comparison of once daily dose of 0.3% nepafenac alone and three times dose of 0.1% nepafenac alone in pain and inflammation control after phacoemulsification.

PURPOSE: To compare the efficacy of a once-daily dose of 0.3% nepafenac and three times daily dose of 0.1% nepafenac in controlling pain and inflammation following phacoemulsification. METHODS: In this prospective randomized control single-blind study. patients who underwent uneventful phacoemulsification were divided into two groups. Group A received 0.1% nepafenac eye drops three times/day for 4 weeks and group B received 0.3% nepafenac eye drops once daily for 4 weeks following phacoemulsification. All the patients received moxifloxacin 0.5% eye drops four times/day for 2 weeks. None of the patients in any group received any form of corticosteroids. RESULTS: The mean age of the patients in group A was 63.55 ± 8.5 years, while in group B, it was 60.05 ± 7.76 years. There was no significant result in the preoperative baseline demographics and intraoperative parameters between both the groups. The results were statistically insignificant in terms of inflammatory markers between both groups on day 1. But, on day 7, group B showed better results in terms of lid edema, conjunctival congestion, and anterior chamber cells. The patients in group B also perceived significantly less pain on day 1 (P = 0.02) and day 7 (P < 0.001). The central macular thickness was also significantly lower in group B at day 30. (: P < .001) and day 90 (P < .001), respectively. CONCLUSION: Once-daily dose of higher concentrated nepafenac (0.3%) is equally effective and shows better results than 0.1% nepafenac for pain and inflammation control.

Meta-herpetic ulcer following intravitreal bevacizumab.

PURPOSE: To report a case of meta-herpetic ulcer that developed after intravitreal bevacizumab injection. METHODS: A 55-year-old man with type 2 diabetes mellitus and nephropathy received intravitreal injection of bevacizumab in his right eye for proliferative diabetic retinopathy with macular edema. RESULTS: Two days after the injection, the patient presented with severe pain, redness, and photophobia, and decreased visual acuity in the right eye. The cornea showed a paracentral epithelial erosion with heaped margins with subepithelial haze and punctate keratopathy, and high intraocular pressure. He initially responded to topical antiviral and antiglaucoma medications. However, it rapidly progressed to a geographic ulcer on initiation of mild steroid and became resistant to conventional medical management. His nephropathy precluded treatment with full dose of systemic antivirals and antiglaucoma drugs. Subsequently, it healed after a paramedian tarsorrhaphy was performed. CONCLUSION: Herpetic epithelial keratitis following intravitreal bevacizumab is a rare occurence. However, this case is the first report of progression to a meta-herpetic ulcer.

Congenital primary primitive neuroectodermal tumor of the orbit in a newborn.

INTRODUCTION: Primitive neuroectodermal tumors arise from the progenitor cells of the neural crest, in the central nervous system or other peripheral locations. CASE PRESENTATION: We report a rare case of a congenital malignant tumor, diagnosed as a primary orbital primitive neuroectodermal tumor on histopathological examination. CONCLUSION: Multidisciplinary management with adjuvant chemotherapy needed for the management of these cases.

COVID-19-associated optic neuritis - A case series and review of literature.

Neuroophthalmic manifestations are very rare in corona virus disease-19 (COVID-19) infection. Only few reports have been published till date describing COVID-19-associated neuroophthalmic manifestations. We, hereby, present a series of three cases who developed optic neuritis during the recovery period from COVID-19 infection. Among the three patients, demyelinating lesions were identified in two cases, while another case was associated with serum antibodies against myelin oligodendrocyte glycoprotein. All three patients received intravenous methylprednisolone followed by oral steroids according to the Optic Neuritis Treatment Trail ptotocol. Vision recovery was noted in all three patients, which was maintained at 2 months of the last follow up visit.

Acute Endothelial Graft Rejection Following COVID-19 Infection.

Here, we report a case of acute endothelial graft rejection following coronavirus disease 2019 (COVID-19). A 57-year-old woman who underwent therapeutic penetrating keratoplasty for a perforated infectious corneal ulcer in her right eye developed severe acute respiratory syndrome coronavirus 2 infection, which required intensive care and treatment with steroids. Acute endothelial graft rejection was seen at three weeks postoperatively and managed with high-dose corticosteroids. Despite standard therapy, secondary graft failure was observed. Immune dysregulation associated with COVID-19 may be a significant cause of acute endothelial graft rejection among keratoplasty patients with COVID-19.

Exudative retinal detachment in COVID-19 - associated rhino-orbital mucormycosis - A rare clinical finding.

Rhino-orbital-cerebral mucormycosis is a life-threatening, opportunistic invasive fungal infection. Patients with moderate to severe coronavirus disease 2019 (COVID-19) infection are more vulnerable to it. Varied clinical presentations can be seen in patients with orbital mucormycosis starting from conjunctival chemosis, proptosis, ptosis, restriction of extraocular movements, exposure keratitis, neurotrophic keratitis, and central retinal artery occlusion. Exudative retinal detachment in a patient with orbital mucormycosis is a rare clinical entity. We, hereby, report a case of orbital mucormycosis with exudative retinal detachment in a patient post-COVID-19 infection.

Complications and visual outcome of sutureless, scleral fixated intraocular lens in cases with traumatic aphakia.

PURPOSE: The aim of this study is to describe the complications and outcome of sutureless scleral fixated intraocular lens (SFIOL) implantation in traumatic aphakia. SETTING: The study was conducted in a tertiary eye care centre in South India. DESIGN: The study involved a retrospective data analysis. METHODS: Medical records of cases with traumatic aphakia who had undergone sutureless SFIOL implantation in the last 2 years were included in the study. Data on intraoperative and postoperative complications and visual outcome were collected and analysed. RESULTS: In total, 45 cases were recruited. Mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from preoperative 1.64 ± 0.45 to 0.63 ± 0.36 at last follow-up visit, and the difference was statistically significant (p < 0.0001). Final logMAR BCVA was worse than one in three patients who had associated posterior segment pathology. There was no incidence of intraoperative haptic rebound into the vitreous cavity or intraocular lens (IOL) drop. Four cases had hypotony, two cases had choroidal detachment, four cases had raised intraocular pressure (IOP), eight cases had transient corneal oedema and six patients had mild dispersed vitreous haemorrhage during immediate postoperative period. Six patients had postoperative cystoid macular oedema (CME). Two cases developed glaucoma. None of the patients had postoperative haptic exposure, retinal detachment (RD), iris capture of IOL or SFIOL dislocation till the last follow-up. CONCLUSION: Final visual outcome of sutureless SFIOL implantation in traumatic aphakia may be affected by concomitant posterior segment pathology. The immediate and late postoperative complications noted in our study were comparable with other similar studies. However, longer follow-up is needed to detect RD and angle recession glaucoma at the earliest and initiate therapy.

Microheterogeneity-induced conduction slowing and wavefront collisions govern macroscopic conduction behavior: A computational and experimental study.

The incidence of cardiac arrhythmias is known to be associated with tissue heterogeneities including fibrosis. However, the impact of microscopic structural heterogeneities on conduction in excitable tissues remains poorly understood. In this study, we investigated how acellular microheterogeneities affect macroscopic conduction under conditions of normal and reduced excitability by utilizing a novel platform of paired in vitro and in silico studies to examine the mechanisms of conduction. Regular patterns of nonconductive micro-obstacles were created in confluent monolayers of the previously described engineered-excitable Ex293 cell line. Increasing the relative ratio of obstacle size to intra-obstacle strand width resulted in significant conduction slowing up to 23.6% and a significant increase in wavefront curvature anisotropy, a measure of spatial variation in wavefront shape. Changes in bulk electrical conductivity and in path tortuosity were insufficient to explain these observed macroscopic changes. Rather, microscale behaviors including local conduction slowing due to microscale branching, and conduction acceleration due to wavefront merging were shown to contribute to macroscopic phenomena. Conditions of reduced excitability led to further conduction slowing and a reversal of wavefront curvature anisotropy due to spatially non-uniform effects on microscopic slowing and acceleration. This unique experimental and computation platform provided critical mechanistic insights in the impact of microscopic heterogeneities on macroscopic conduction, pertinent to settings of fibrotic heart disease.