{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:26:00Z","timestamp":1787775960547,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To estimate the pattern of ocular manifestations, as observed clinically and radiologically, and associated risk factors in cases of coronavirus disease 2019 (COVID-19)-related rhino-orbital cerebral mucormycosis (ROCM) during the second wave at presentation to the hospital in northern India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A total of 35 patients of ROCM associated with active cases of COVID-19 or recovered cases of COVID-19 presenting to the Ophthalmology outpatient department or admitted in the COVID ward of the hospital with clinical features suggestive of ROCM. They were confirmed as mucormycosis on KOH and fungal cultures of nasal scrapings and histopathology of debrided tissue. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessment of ROCM-associated COVID-19 during the second outbreak of the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The total patients included were 35, which ranged in the age group of 52.91+\/- 11.93 years, and the male-to-female ratio was 24:11. The duration between the first positive COVID report and onset of COVID-19-associated ROCM was 9.46+\/-11.63 days. The majority (82.9%; n-29) either were diabetics or had high blood glucose levels during the recent COVID-19 infection. 45.7% of patients gave a history of steroid therapy. The most common ocular clinical features were ptosis (80%) and loss of vision 48.7%, respectively. There was diffuse involvement of sinuses in 18 cases (51.4%). Staging based on magnetic resonance imaging scans showed that 7 (20%) had stage II, 20 (57.1%) had stage III, and 28.7% had stage IV disease. Ten patients had varied intracranial extension ranging from meningitis and cavernous sinus thrombophlebitis\/thrombosis to brain abscess.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>COVID-associated ROCM was very rapidly spreading and more destructive. Ptosis and loss of vision related to third nerve involvement and CRAO, respectively, were alarming signs and bad prognostic indicators to the patient. Intracranial involvement and CRAO were poor prognostic features in this type of mucormycosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_1161_24","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T09:03:35Z","timestamp":1736759015000},"page":"259-267","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Estimation of the pattern of ocular manifestations, risk factors, and imaging of rhino-orbital-cerebral mucormycosis in COVID-19 patients"],"prefix":"10.4103","volume":"14","author":[{"given":"Rajwinder","family":"Kaur","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Budhiraja","sequence":"additional","affiliation":[{"name":"Department of ENT, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upasana","family":"Bhumbla","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjot","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandana","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritesh","family":"Singla","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akashdeep","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekta","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Dahiya","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,1,13]]},"reference":[{"key":"R1-20260109","first-page":"1","article-title":"Fungal co-infections associated with global COVID-19 pandemic: A clinical and diagnostic perspective from China","volume":"31","author":"Song","year":"2020","journal-title":"Mycopathologia"},{"key":"R2-20260109","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.2214\/AJR.21.26205","article-title":"CT and MRI findings of invasive mucormycosis in the setting of COVID-19: Experience from a single center in India","volume":"217","author":"Joshi","year":"2021","journal-title":"AJR Am J Roentgenol"},{"key":"R3-20260109","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3390\/microorganisms9030523","article-title":"Epidemiology of mucormycosis in India","volume":"9","author":"Prakash","year":"2021","journal-title":"Microorganisms"},{"key":"R4-20260109","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.idc.2015.10.011","article-title":"Mucormycoses","volume":"30","author":"Farmakiotis","year":"2016","journal-title":"Infect Dis Clin North Am"},{"key":"R5-20260109","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1111\/coa.13175","article-title":"A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis: has anything changed in the past 20 years","volume":"43","author":"Vaughan","year":"2018","journal-title":"Clin Otolaryngol"},{"key":"R6-20260109","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4103\/ijo.IJO_1565_21","article-title":"Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India \u2013Collaborative OPAI-IJO study on mucormycosis in COVID-19 (COSMIC) Report 1","volume":"69","author":"Sen","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R7-20260109","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0039-6257(05)80041-4","article-title":"Survival factors in rhino-orbital-cerebral mucormycosis: Major review","volume":"39","author":"Yohai","year":"1994","journal-title":"Surv Ophthalmol"},{"key":"R8-20260109","doi-asserted-by":"crossref","first-page":"15","DOI":"10.18869\/acadpub.cmm.2.4.15","article-title":"Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral Mucormycosis - A retrospective analysis","volume":"2","author":"Abdollahi","year":"2016","journal-title":"Curr Med Mycol"},{"key":"R9-20260109","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/myc.12474","article-title":"Mucormycosis in Iran: A systematic review","volume":"59","author":"Vaezi","year":"2016","journal-title":"Mycoses"},{"key":"R10-20260109","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/mmy\/myy060","article-title":"A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment","volume":"57","author":"Prakash","year":"2019","journal-title":"Med Mycol"},{"key":"R11-20260109","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.4103\/IJO.IJO_356_23","article-title":"Study of rhino-orbital-cerebral mucormycosis and its correlates during COVID-19 pandemic in a tertiary eye care institute of central India","volume":"71","author":"Verma","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"R12-20260109","doi-asserted-by":"crossref","first-page":"600","DOI":"10.4269\/ajtmh.22-0298","article-title":"Clinicoradiological profile of COVID-19-associated rhino-orbital cerebral mucormycosis with a focus on computed tomography: A clinical case series and review","volume":"109","author":"Prabhakar","year":"2023","journal-title":"Am J Trop Med Hyg"},{"key":"R13-20260109","doi-asserted-by":"crossref","first-page":"102146","DOI":"10.1016\/j.dsx.2021.05.019","article-title":"Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India","volume":"15","author":"Singh","year":"2021","journal-title":"Diabetes Metab Syndr"},{"issue":"Suppl 3","key":"R14-20260109","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/myc.12247","article-title":"Mucormycosis in haematological patients: Case report and results of prospective study in Saint Petersburg, Russia","volume":"57","author":"Klimko","year":"2014","journal-title":"Mycoses"},{"key":"R15-20260109","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3174\/ajnr.A1808","article-title":"The \u201cBlack Turbinate\u201d sign: An early MR imaging finding of nasal mucormycosis","volume":"31","author":"Safder","year":"2010","journal-title":"AJNR Am J Neuroradiol"},{"key":"R16-20260109","doi-asserted-by":"crossref","first-page":"100222","DOI":"10.1016\/j.xocr.2020.100222","article-title":"Black turbinate sign: MRI finding in acute invasive fungal sinusitis","volume":"17","author":"Taylor","year":"2020","journal-title":"Otolaryngol Case Rep"},{"key":"R17-20260109","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.4103\/ijo.IJO_3763_20","article-title":"COVID-19 and orbital mucormycosis","volume":"69","author":"Sarkar","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R18-20260109","first-page":"e10726","article-title":"Rhino-orbital mucormycosis associated with COVID-19","volume":"12","author":"Mehta","year":"2020","journal-title":"Cureus"},{"key":"R19-20260109","doi-asserted-by":"crossref","first-page":"298","DOI":"10.3390\/jof7040298","article-title":"When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for mucormycosis","volume":"7","author":"John","year":"2021","journal-title":"J Fungi (Basel)"},{"key":"R20-20260109","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.4103\/ijo.IJO_1439_21","article-title":"Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis","volume":"69","author":"Sreshta","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R21-20260109","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s43163-022-00342-7","article-title":"Imaging of COVID-19-associated rhino-orbital-cerebral mucormycosis: Imaging analysis of 120 patients","volume":"38","author":"Agrawal","year":"2022","journal-title":"Egypt J Otolaryngol"},{"key":"R22-20260109","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1067\/j.cpradiol.2021.09.004","article-title":"Magnetic resonance imaging in coronavirus disease-2019 associated rhino-orbital-cerebral mucormycosis (CA-ROCM)-imaging analysis of 50 consecutive patients","volume":"51","author":"Yadav","year":"2022","journal-title":"Curr Probl Diagn Radiol"},{"key":"R23-20260109","doi-asserted-by":"crossref","first-page":"102267","DOI":"10.1016\/j.dsx.2021.102267","article-title":"COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum","volume":"15","author":"Dubey","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"R24-20260109","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.4103\/ijo.IJO_1165_21","article-title":"Rhino-orbito-cerebral mucormycosis-Guidelines for diagnosis, staging and management","volume":"69","author":"Honavar","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R25-20260109","first-page":"348","article-title":"Rhino orbito-cerebral mucormycosis. Management strategies to avoid or limit intracraneal affection and improve survival","volume":"66","author":"Plowes","year":"2015","journal-title":"Acta Otolaryngol Esp"},{"key":"R26-20260109","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/01.iop.0000225418.50441.ee","article-title":"Indications for orbital exenteration in mucormycosis","volume":"22","author":"Hargrove","year":"2006","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"R27-20260109","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/IOP.0000000000000488","article-title":"The role of adjunctive therapies in the management of invasive sinoorbital infection","volume":"31","author":"Colon-Acevedo","year":"2015","journal-title":"Ophthalmic Plast Reconstr Surg"},{"issue":"S3","key":"R28-20260109","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1007\/s12070-018-1384-6","article-title":"Sinonasal mucormycosis: A to Z","volume":"71","author":"Singh","year":"2019","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"R29-20260109","doi-asserted-by":"crossref","first-page":"101092","DOI":"10.1016\/j.ajoc.2021.101092","article-title":"Medical and surgical treatment of rhino-orbital-cerebral mucormycosis in a child with leukemia","volume":"22","author":"Levinsen","year":"2021","journal-title":"Am J Ophthalmol Case Rep"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1161_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:46:47Z","timestamp":1787773607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1161_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1161_24","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-07-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}