The outbreak of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) through the latest waves of the pandemic in several countries gathered attention to this rare fungal infection. This prospective observational study aims to evaluate the demographic and medical profile, clinical signs and symptoms (with a special focus on ophthalmic findings), imaging features, and the outcome of CA-ROCM patients. The collaborative study of COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis in Iran (CA-ROCM-IR) has been conducted in 8 tertiary referral ophthalmology centers among different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination, and underwent standard accepted treatment strategy based on the disease stage. The present report is the preliminary results of this project study. Two hundred seventy-four CA-ROCM patients, including 150 males (54.7%), who had a mean age of 56.8 ± 12.44 years, were enrolled. Diabetes mellitus was the most prevalent (82.8%) medical disease among the patients. Supplemental oxygen administration and corticosteroid use due to COVID-19 were present in a large proportion of the patients (68.2%, and 73.7% respectively). The most common primary complaints were facial pain (47.4%), facial swelling (38.3%), and nasal discharge (32.5%). Ptosis (58%), periorbital swelling (46%), and nasal congestion (40.5%) were common signs and symptoms among CA-ROCM patients. A majority of the patients (80.3%) were diagnosed at stage 3 or higher of ROCM and the rate of ocular involvement in whom was 92.3%. The most affected paranasal sinus was the ethmoid sinus (75.2%), followed by the maxillary sinus (70.8%). A total of 30 patients (10.9%) had expired before discharge from hospitals. Patients with a history of cigarette smoking (OR = 7.25), ICU admission (OR = 87.36), higher stage of the ROCM (OR = 4.22), receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (TRAMB) (OR = 4.20), and bilateral ocular involvement (OR = 2.94) had upper odds for death before discharge from hospital. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (OR = 0.058, P = 0.006). Also, GEE analysis showed statistically significant higher mean LogMAR visual acuity score among expired patients (3.71, 95% CI: 3.04–4.38) compared to patients who were discharged from hospitals (2.42, 95% CI: 2.16–2.68) (P < 0.001).
Background: Mitomycin C (MMC) is used to prevent corneal opacity after photorefractive keratectomy (PRK). This study sought to determine the effect of MMC on tear film function after PRK in eyes with mild-to-moderate myopia.Methods: This prospective, contralateral eye comparison was conducted on 30 eyes of 15 patients with low-to-moderate myopia referred to Alzahra Eye Hospital, Zahedan, Iran. The eyes of the control group underwent PRK with a balanced salt solution, while the fellow eyes in the intervention group underwent PRK with 0.02% MMC for 25 s. The tear breakup time test (TBUT) and basic Schirmer test results of eyes in the control and intervention groups were compared at baseline and 1, 3, and 6 months postoperatively. Tear osmolarity was recorded and compared at baseline and 3 months postoperatively. Results: The mean ± standard deviation (SD) age of participants was 27.53 ± 7.04 years. No statistically significant differences were observed in the means ± SDs for tear osmolarity, TBUT, and basic Schirmer test values (all P > 0.05) between MMC-treated eyes and untreated fellow eyes at baseline and during postoperative follow-up. The means ± SDs for tear osmolarity, TBUT, and basic Schirmer test results were comparable in both groups between the baseline and postoperative follow-ups (all P > 0.05). Conclusions: Single application of a standard dose of MMC (0.02%) for 25 s in PRK did not change tear stability, tear production, or variation in tear dynamics up to 6 months postoperatively in eyes with low-to-moderate myopia. Future longitudinal studies with a longer follow-up and a larger sample size are warranted to confirm our findings.
Background Endophthalmitis is one of the most important complications after cataract surgery and in case event can cause many symptoms, such as severe decrease in eyesight and/or even the loss of vision. Employing methods to reduce this problem is very important. The aim of this study was to evaluate the effect of intracameral cefuroxime after cataract surgery on corneal endothelial cell counts and its morphology. Methods In this study, 32 eyes of 30 patients underwent endothelial cell count and morphology assessment by ConfoScan III device before and 1 month after cataract surgery. All patients undertaken cataract surgery by one surgeon and by one method. Intracameral cefuroxime (1 mg/0.1 ml) was used as prophylaxis of postoperative endophthalmitis at the end of operation. Results In this study, the rate of corneal endothelial cell loss 1 month after cataract surgery was 8.4%, and the rate of endothelial cells polymegathism before and after cataract surgery did not differ statistically. During the follow-up period, there were no cases of endophthalmitis or other complications. Conclusion With regard to the importance of the intracameral cefuroxime in a reduction in the rate of endophthalmitis after cataract surgery and that harmful effects on the endothelial cells were not seen, this method can be considered as a suitable method for endophthalmitis prophylaxis.
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