Korean J Ophthalmol > Volume 36(4); 2022 > Article
Korean Journal of Ophthalmology 2022;36(4):356-365.
DOI: https://doi.org/10.3341/kjo.2022.0037    Published online June 15, 2022.
Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome
Amit Kumar Deb1, Rakesh Singh2, Subashini Kaliaperumal1, Arun Alexander3, Tanmay Gokhale1, Sandip Sarkar1
1Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
2Department of Microbiology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
3Department of Otorhinolaryngology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
Correspondence:  Sandip Sarkar, Tel: 91-98627-68998, Fax: 91-38123-50245, 
Email: drsandip19@gmail.com
Received: 17 March 2022   • Revised: 13 May 2022   • Accepted: 24 May 2022
Abstract
Purpose
Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM.
Methods
Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome.
Results
On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009).
Conclusions
The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.
Key Words: Mucormycosis, Retrospective studies, Risk factors, Treatment outcome
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