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Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital

International Journal of Ophthalmology(English edition) 2022年第4期15卷 527-532页

作者： Smiti Rani Srivastava Purban Ganguly Debasis Barman Sudip Das Manimoy Bandyopadhyay Asim Kumar Ghosh Subhra Sarkar Amitabha Sengupta Sarbari Swaika pritam chatterjee Amit Kumar Gupta Alok Ranjan Mondal Soumyajit Guha Sinjita Dutta Souvik Adhikari Aditi Kaushik Partha Sundar Biswas Asif Ayub Department of Ophthalmology Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial HospitalKolkata 999008India

AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) ***: All COVID associated mucormycosis(CAM) patients underwent comprehensive multidisciplinar y examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31(34.8%) had orbital apex syndrome. Sixty-six(74.2%) of such patients had pre-existing diabetes mellitus, 18(58%) patients had prior documented use of steroid use, and 55(61.8%) had no light perception(LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen(19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34(38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.

关键词： rhino-orbito-cerebral mucormycosis COVID associated mucormycosis orbital exenteration endoscopic paranasal sinus debridement orbital apex syndrome

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