• Comprehensive Ophthalmology, Oculoplastics/Orbit

    Following an outbreak of COVID-19–associated rhino-orbito cerebral mucormycosis (RCOM) treated at a tertiary care hospital in India, investigators conducted a retrospective case-control study to determine cumulative mortality rates for patients presenting with RCOM and risk factors for the condition. 

    Study design

    Seventy-three consecutive patients with RCOM were included in the study; 89% were unvaccinated. Inclusion criteria included death after admission or a minimum follow-up of 30 days. The primary outcome measure was death.

    Outcomes

    Ninety-eight percent of patients had received intravenous corticosteroids and 74% had diabetes. Development of RCOM occurred at a mean of 31 days after COVID-19 recovery. Thirty-six percent of patients died during the study period; the cumulative probability of death was 26% at day 7, 42% at day 14, and 53% at day 21. Risk factors for death included comorbid uncontrolled diabetes, worse visual acuity, more severe COVID-19 disease before RCOM development, longer duration of supplemental oxygen, and a greater need for assisted ventilation.

    Limitations

    As this study was conducted between March 1 and May 30, 2021, it likely does not include patients who have been infected with the current omicron strain of the virus. It is unclear whether this study will be translatable to current and future COVID-19 strains. In addition, the treatment provided appeared to be often based on the discretion of the treating physician and the availability of intravenous amphotericin B.

    Clinical significance

    Rhino-orbito cerebral mucormycosis has been previously reported to be associated with uncontrolled diabetes and the use of high-dose systemic corticosteroids. This study demonstrates the high COVID-19 mortality rate associated with RCOM. In addition, a significant percentage of patients in this study were not vaccinated. Clinicians should have a high index of suspicion of RCOM and treat aggressively with functional endoscopic sinus surgery and intravenous antifungal agents to decrease the chance of death.