Kim Usha, Perzia Brittany, Kulkarni Pooja, Rajiniganth Mahalingam, Sundar Balagiri, Robin Alan L, Garg Shukla Aakriti, Maeng Michelle M
Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, India.
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.
Orbit. 2025 Feb;44(1):24-33. doi: 10.1080/01676830.2024.2377249. Epub 2024 Jul 25.
Outbreaks of mucormycosis were reported worldwide throughout the COVID-19 pandemic. We report clinical outcomes of a treatment protocol for COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM).
Patients with biopsy-proven mucormycosis and COVID-19 were included. All received intravenous amphotericin B deoxycholate 1 mg/kg and surgical endoscopic sinus debridement (FESS). Those with rhino-orbital or cerebral disease limited to the cavernous sinus were eligible for transcutaneous retrobulbar amphotericin B (TRAMB). Patients were followed with weekly imaging, endoscopic examinations, and serial debridement as necessary. Patients were discharged on oral posaconazole for 6 months.
In total, 264 patients were followed for a mean of 2.5 months. On presentation, 163 patients (174 eyes) had eye involvement. Of these, 141 eyes (81.0%) had light perception or worse vision. By the last follow-up, 163 patients (176 eyes) were affected, and of these, 96 eyes (54.5%) had no light perception. Twenty-one patients (8%) died and 3 orbits (0.5%) were exenterated. There was no change in mortality ( = 0.38) or exenteration ( = 0.38) in the 55 patients who received TRAMB compared to patients with rhino-orbital or cerebral disease limited to the cavernous sinus who did not. Asymptomatic COVID-19 was associated with higher mortality than symptomatic COVID-19 ( = 0.025). Uncontrolled diabetes was a risk factor for death ( = 0.022). New diabetes was associated with increased mortality versus pre-existing diabetes ( = 0.005).
A multidisciplinary approach is crucial to manage COVID-19-ROCM. In our cohort, TRAMB therapy did not increase mortality or exenteration rates. While poor vision on presentation was profound, some vision recovery was noted with treatment. COVID-19 immune dysregulation may predispose patients to ROCM, particularly those with asymptomatic disease.
在新冠疫情期间，全球报告了毛霉菌病的暴发情况。我们报告了一种针对新冠相关鼻眶脑型毛霉菌病（ROCM）的治疗方案的临床结果。
纳入经活检证实为毛霉菌病且感染新冠的患者。所有患者均接受静脉注射脱氧胆酸两性霉素B 1mg/kg以及外科内镜鼻窦清创术（功能性内镜鼻窦手术）。鼻眶或脑部疾病局限于海绵窦的患者有资格接受经皮球后两性霉素B（TRAMB）治疗。患者每周接受影像学检查、内镜检查，并根据需要进行系列清创术。患者出院时口服泊沙康唑6个月。
总共对264例患者进行了平均2.5个月的随访。就诊时，163例患者（174只眼）有眼部受累。其中，141只眼（81.0%）有光感或视力更差。到最后一次随访时，163例患者（176只眼）受到影响，其中96只眼（54.5%）无光感。21例患者（8%）死亡，3个眼眶（0.5%）被摘除。与未接受TRAMB治疗的鼻眶或脑部疾病局限于海绵窦的患者相比，接受TRAMB治疗的55例患者的死亡率（P = 0.38）或眼眶摘除率（P = 0.38）没有变化。无症状新冠与比有症状新冠更高的死亡率相关（P = 0.025）。未控制的糖尿病是死亡的危险因素（P = 0.022）。新发糖尿病与既往存在糖尿病相比，死亡率增加（P = 0.005）。
多学科方法对于管理新冠-ROCM至关重要。在我们的队列中，TRAMB治疗并未增加死亡率或眼眶摘除率。虽然就诊时视力差很严重，但治疗后仍有一些视力恢复。新冠免疫失调可能使患者易患ROCM，尤其是那些无症状疾病患者。
