Naik Milind N, Rath Suryasnata
Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India.
Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Bhubaneshwar, India.
Semin Ophthalmol. 2022 Apr 3;37(3):279-283. doi: 10.1080/08820538.2021.1946094. Epub 2021 Jul 14.
To report and validate an objective staging system for COVID-related Rhino-Orbito-Cerebral mucormycosis (ROCM).
Proof of concept of a new ROC staging system was devised for COVID-related ROCM. The staging system was based on data points drawn from a comprehensive ophthalmic examination, diagnostic endoscopy, and appropriate imaging of orbit, paranasal sinuses and brain in post-COVID ROCM patients to formulate the final staging expressed as ROC. Each stage in the sinus, orbit and brain was graded into three levels of severity of disease. Progressive stages necessitated more active and urgent intervention and poorer prognosis. Finally, ten consecutive ROCM patients were independently staged by two blinded clinicians by examining clinical photographs and radiological images and the results matched for concordance.
Each component of the staging: Rhino, Orbital, and Cerebral were graded 0-3 based on severity. Each stage was matched with a recommended management plan. The final ROC grading by two independent clinicians showed a high degree of concordance - maximum for orbit grade (100%) followed by brain (90%) and sinuses (80%). Overall ROC staging had 70% concordance. Extrapolation of final ROC staging of two clinicians showed 60% match. When we allowed for one-point difference in the ROC staging system the concordance between two clinicians improved to 100% and the management plan matched in 90%.
The proposed ROC staging system based on objectively defined clinico-radiological criteria of the three components of COVID-related ROCM is simple-to-use and has high concordance when validated by independent clinicians. The staging helps devise a management plan and has prognostic value.
报告并验证一种针对新冠相关鼻眶脑毛霉菌病（ROCM）的客观分期系统。
为新冠相关ROCM设计了一种新的RO分期系统的概念验证。该分期系统基于新冠后ROCM患者全面眼科检查、诊断性内镜检查以及眼眶、鼻窦和脑部的适当影像学检查所获取的数据点，以制定最终的RO分期。鼻窦、眼眶和脑部的每个阶段根据疾病严重程度分为三个等级。进展期需要更积极和紧急的干预，且预后较差。最后，两名盲法临床医生通过检查临床照片和放射影像对连续10例ROCM患者进行独立分期，结果进行一致性匹配。
分期的每个组成部分：鼻、眼眶和脑部根据严重程度分为0 - 3级。每个阶段都匹配了推荐的管理计划。两名独立临床医生的最终RO分级显示出高度一致性——眼眶分级的一致性最高（100%），其次是脑部（90%）和鼻窦（80%）。总体RO分期的一致性为70%。两名临床医生最终RO分期的外推显示匹配度为60%。当我们在RO分期系统中允许有一分的差异时，两名临床医生之间的一致性提高到100%，管理计划的匹配度为90%。
所提出的基于新冠相关ROCM三个组成部分客观定义的临床放射学标准的RO分期系统易于使用，经独立临床医生验证后具有高度一致性。该分期有助于制定管理计划并具有预后价值。
