PDF(Pubmed)
Abstract：
OBJECTIVE: To share clinical pattern of presentation, the modalities of surgical intervention and the one month post-surgical outcome of rhino-orbito-mucormycosis (ROCM) cases.
METHODS: All COVID associated mucormycosis (CAM) patients underwent comprehensive multidisciplinary 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.
CONCLUSIONS: 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.
METHODS: All COVID associated mucormycosis (CAM) patients underwent comprehensive multidisciplinary 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.
CONCLUSIONS: 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.
摘要：
目的：分享临床表现模式，手术干预的方式和手术后一个月的鼻-或毛霉菌病（ROCM）病例的结果。
方法：所有COVID相关毛霉菌病（CAM）患者都接受了眼科医生的综合多学科检查，耳鼻喉科医师和内科医生。研究中包括有临床和放射学证据表明眶尖受累的患者。对每位患者进行了适当的药物和手术干预。干预后1个月对患者进行随访。
结果：在89例CAM患者中，31（34.8％）患有眶尖综合征。这些患者中有66例(74.2%)患有预先存在的糖尿病，18（58％）患者先前有记录使用类固醇，55（61.8％）没有光感知（LP）呈现视力。上睑下垂,突增,完全眼肌麻痹是常见的临床表现。此类患者中有17例（19.1％）的海绵窦受累。在大多数情况下，鼻旁窦和眼眶有或没有眼睑保留有限的眼眶切除术的内镜下清创。34例（38.2％）患者可以保留患眼的视力。
结论：CAM患者的心尖受累发生得非常快。它不仅会导致视力丧失，还会牺牲眼球，眼眶内容物和眼睑。早期诊断和及时干预可以挽救生命，视力和多余的残缺手术。
方法：所有COVID相关毛霉菌病（CAM）患者都接受了眼科医生的综合多学科检查，耳鼻喉科医师和内科医生。研究中包括有临床和放射学证据表明眶尖受累的患者。对每位患者进行了适当的药物和手术干预。干预后1个月对患者进行随访。
结果：在89例CAM患者中，31（34.8％）患有眶尖综合征。这些患者中有66例(74.2%)患有预先存在的糖尿病，18（58％）患者先前有记录使用类固醇，55（61.8％）没有光感知（LP）呈现视力。上睑下垂,突增,完全眼肌麻痹是常见的临床表现。此类患者中有17例（19.1％）的海绵窦受累。在大多数情况下，鼻旁窦和眼眶有或没有眼睑保留有限的眼眶切除术的内镜下清创。34例（38.2％）患者可以保留患眼的视力。
结论：CAM患者的心尖受累发生得非常快。它不仅会导致视力丧失，还会牺牲眼球，眼眶内容物和眼睑。早期诊断和及时干预可以挽救生命，视力和多余的残缺手术。
