Corneal Manifestations and Treatment among Patients with COVID-19-associated Rhino-orbito-cerebral Mucormycosis

An original research paper entitled "Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis", published in the Indian Journal of Ophthalmology, has mentioned the effectiveness of the combination of systemic amphotericin and/or posaconazole with topical or intraocular administration of amphotericin B in mucormycosis, saying it is recommended for all patients as it has better corneal penetration and good activity against Mucoromycetes.

Mucormycosis is an opportunistic invasive fungal infection with high prevalence in immunocompromised patients.

Researchers in this study reported corneal manifestations in patients with COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM).

The study was a retrospective, observational, and record-based analysis of ROCM patients with corneal involvement.

Study Summary

• Over a 3-month duration, 220 patients were diagnosed to have ROCM. The patients were aged (mean age) 52.84 ± 12.8 years at the time of diagnosis.
• Corneal manifestations were reported in 32 patients.
• Systemic mucormycosis, uncontrolled diabetes (29 patients), recent COVID-19 infection (32 patients), and injudicious use of systemic steroids (13 patients) were the associated risk factors.
• The right eye (RE), left eye (LE), and both eyes were affected in nine patients, 20 patients, and three patients, respectively.
• The round-oval corneal ulcer was recorded in 9 patients.
• One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis.
• A corneal melt and inferior conjunctival xerosis with chemosis were seen in three patients each.
• On six patients, orbital exenteration was performed.
• Corneal ulcers healed in five patients.
• Along with systemic antifungals, topical eye drops of amphotericin (0.5 mg/ml), cycloplegic, antiglaucoma medications, and lubricant eye drops were started.

Concluding further, they said that our study found that the most common mucormycosis manifestation was a central corneal ulcer.

We found that 0.5 mg/ml of amphotericin eye drops were highly effective in the treatment.

Further Reading

Yadav, Rekha; Madan, Siddharth; Rohatgi, Jolly; Sahu, Pramod Kumar; Das, Shukla1; Tandon, Anupama2; Rai, Puja; Verma, Priya; Singh, Jubin; Bajaj, Ishita. Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis. Indian Journal of Ophthalmology 71(1):p 101-108, January 2023. | DOI: 10.4103/ijo.IJO_1477_22