IMPORTANCE An outbreak of COVID-19-associated rhino-orbitocerebral mucormycosis (CAM) has occurred in many parts of the world. Although the clinical profile and risk factors for CAM have been studied, cumulative mortality and its risk factors have not.OBJECTIVE To report the cumulative mortality rates at different times in cases with CAM and identify risk factors for CAM-associated mortality. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case-control study was conducted from March 1 to May 30, 2021, in a tertiary care multispecialty hospital in western India. All patients diagnosed with CAM and with a minimum follow-up of 30 days or those who died before 30 days due to CAM were included. MAIN OUTCOMES AND MEASURECumulative mortality in CAM using survival analysis.RESULTS A total of 73 consecutive patients with CAM with a mean (SD) age of 53.5 (12.5) years were included in the analysis, of whom 48 (66%) were men. CAM developed at a median of 28 (IQR, 15-45; range, 4-90) days after recovery from COVID-19. Of the 73 patients with CAM, 26 (36%) died; the cumulative probability of death was 26% (95% CI, 16%-41%) at day 7 and doubled to 53% (95% CI, 39%-69%) at day 21. Sinus debridement was performed in 18 of 51 patients (35%), and 5 of 52 (10%) underwent exenteration, whereas intravenous lyophilized amphotericin B was administered to 48 patients (66%). A multivariate Cox proportional hazards regression analysis showed that receiving mechanical ventilation in the past was associated with a nearly 9-fold increased risk of death (hazard ratio [HR], 8.98; 95% CI, 2.13-38.65; P = .003), and patients who had visual acuity of light perception or better had a 46% lower risk of death (HR, 0.56; 95% CI, 0.32-0.98; P = .04). Intravenous amphotericin B administration was associated with a reduced rate of exenteration (0 vs 5 of 25 [20%]; P < .001). On multivariate analysis, those who received intravenous amphotericin B had a 69% reduced risk of death (HR, 0.31; 95% CI, 0.06-1.43; P = .13).CONCLUSIONS AND RELEVANCE These findings suggest that the mortality rate after rhino-orbitocerebral mucormycosis is high and that a subgroup of patients with severe COVID-19 or presenting with severe orbital disease are more likely to die within 10 days of admission.

Purpose. To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. Methods. In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. Results. We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p = 0.49 ). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group ( p = 0.22 ). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences ( p = 0.18 ). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group ( p < 0.001 ). Conclusion. A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

Background: To study the safety and efficacy provided by a minimal and localized anesthesia in cataract surgery. Methods: Randomized controlled trial. A total of 100 patients undergoing cataract surgery were randomly divided into two groups of 50, which respecitvely received conventional topical anesthesia consisting of preservative-free Oxibuprocaine hydrochloride 0.4% drops or minimal localized anesthesia, administered with a cotton bud soaked in preservative-free Oxibuprocaine hydrochloride 0.4% applied to clear cornea on the access sites for 10 s immediately before surgery. The mean outcome measures were intraoperative pain and the incidence of postoperative ocular discomfort. Results: All patients tolerated well the procedure, giving patin scores between 1–3. Fifteen patients (30%) of group 1 and ten of group 2 (25%) required supplemental anesthesia. No intraoperative complications were recorded. No eyes had epithelial defects at the end of the surgery or at postoperative check-ups. Conclusions: Minimal anesthesia in cataract surgery resulted quick, safe and non-invasive.

Aim. This study aims to evaluate the morphology of ganglion cell complex (GCC) along with functional outcomes in patients undergoing vitrectomy with ILM peeling and macular abrasion with Tano diamond dusted membrane scrapers (DDMS) for three different stages of the idiopathic macular hole (IMH). Methods. This retrospective study was conducted between April 2019 and December 2019. 33 patients with IMH were included and divided into three groups: stage I, stage II, and stage IV. All patients were subjected to vitrectomy with ILM peeling. Gentle and vigorous macular abrasion was additionally performed for stage II and stage IV patients, respectively. The best-corrected visual acuity (BCVA), GCC thickness (measured by spectral domain-optical coherence tomography (SD-OCT)), and photopic contrast sensitivity (Rodenstock CV 900 Chart Panel) were determined before surgery and at 1- and 3-month follow-ups. Results. Closure of MH was achieved in all the patients. The difference between the preoperative and one- and three-month postoperative values of BCVA was statistically significant in the three groups ( P < 0.01 ). Contrast sensitivity progressively improved in all patients and was statistically significant ( P < 0.01 ). The reduction in GCC thickness during follow-up was 34%–42% of the preoperative measurements. On comparing the mean GCC thickness of the operated and healthy eyes, it was not statistically significant in stage I patients. However, the same when done in stage II and IV was statistically significant with P value < 0.05 and P < 0.01 , respectively. Conclusion. Combining ILM peeling with macular abrasion in advanced stages of MH may facilitate its closure without significantly affecting the functional outcome.

No abstract

To describe a new technique in removing sub-macular hemorrhages (SMH) in traumatic patients and results. Methods:In this technique, patients with SMH, a complete three port vitrectomy was performed. Using a back flush instrument and soft tip needle, considering safe distance from silicon tip to retina, SMH is swept using gentle flushes to an other site far from the macula in which clots were removed via a retinotomy site. In a case with macular hole, the hemorrhage was drained via the hole.Results: In case one, SMH was swept to the temporal of the macula and removed via a retinotomy. Best corrected visual acuity was improved from hand motion to 20/ 30. In the second patient, four weeks after trauma, SMH was removed and after three weeks the BCVA was improved to 20/25 (after three weeks). In the third case that had traumatic macular hole in first place, the SMH was drained via the macular hole and BCVA was improved from hand motion to 20/100. Conclusion: Sub-Macular hemorrhage sweeping using back flush after a complete vitrectomy seems to be efficacious in restoring macular anatomical and visual function.

Introduction:COVID-19 pandemic has multiple ocular manifestations. We report 2 cases of central serous chorioretinopathy, following COVID19 infection. Case Presentation: We diagnosed two middle aged patients with central serous chorioretinopathy one week post COVID-19 infection. Both patients were admitted in COVID-19 ward. Case 1 was a male diabetic and required ventilator assisted respiration. Case 2 was a female patient with no systemic diseases. Both patients were given intravenous (IV) methylprednisolone for 2 weeks followed by oral prednisolone. Case 1developed CSCR in right eye while the other patient developed CSCR in both eyes. Conclusion: The possibility of developing CSCR should be kept in mind by the treating physician in Covid 19 patients treated with steroids. Early involvement of ophthalmologist can lead to timely and effective management of same

The second wave of COVID-19 in India was associated with higher incidence of Mucormycosis. We report a rare case of 40-year-old Asian male, with Type 2 diabetes mellitus who presented with bilateral sudden loss of vision, ptosis, proptosis, total ophthalmoplegia and central retinal artery occlusion. Computed tomography followed by magnetic resonance imaging was suggestive of bilateral sinusitis, orbital cellulitis, optic neuritis and gross intracranial involvement. Considering his general condition and guarded prognosis for survival, exenteration was deferred. After detailed literature research, we found very few reports of bilateral orbital involvement in cases of COVID-19 associated ROCM. Even after early diagnosis and prompt treatment of ROCM, patient succumbed to the illness. Covid 19 associated bilateral rhino-orbital-cerebral mucormycosis may be a marker of mortality in the affected population.