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Ophthalmic Images
November 17, 2021

Optical Coherence Tomography of Retinal Artery Occlusion Associated With Mucormycosis and COVID-19

Author Affiliations
  • 1Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
  • 2Gian Sagar Medical College and Hospital, Rajpura, Punjab, India
  • 3Lotus Eye Hospital and Institute, Coimbatore, Tamil Nadu, India
JAMA Ophthalmol. 2021;139(11):e214064. doi:10.1001/jamaophthalmol.2021.4064

A 41-year-old woman presented with mucormycosis-induced orbital apex syndrome following SARS-CoV-2 infection. Magnetic resonance imaging showed pansinusitis with thickening and enhancement of the extraocular muscles. A histopathological examination disclosed broad-based, filamentous, aseptate hyphae, suggestive of mucormycosis. A fundus examination showed signs of central retinal artery occlusion, including loss of transparency, presumably from ischemia to the ganglion cell layer and boxcarring of the retinal arterioles. Macular folds on fundus photography with separation of the neurosensory retina from the retinal pigment epithelium on optical coherence tomography were noted (Figure). Prompt treatment with systemic amphotericin B (10 mg/kg/d) and debridement of the sinuses was performed, although the eye was exenterated.

Figure.  
A, Fundus photograph showing multiple yellow macular folds, presumably from ischemia to ganglion cell layer in the macula, and boxcarring (arrowhead) of retinal arterioles. B, A spectral-domain optical coherence tomography line scan showing multiple hyperreflective neurosensory retinal bumps (arrowheads) with patchy separation of neurosensory retina and retinal pigment epithelium (asterisk).

A, Fundus photograph showing multiple yellow macular folds, presumably from ischemia to ganglion cell layer in the macula, and boxcarring (arrowhead) of retinal arterioles. B, A spectral-domain optical coherence tomography line scan showing multiple hyperreflective neurosensory retinal bumps (arrowheads) with patchy separation of neurosensory retina and retinal pigment epithelium (asterisk).

We hypothesize that choroidal congestion because of orbital apex syndrome led to separation of the neurosensory retina from the retinal pigment epithelium. Cases of COVID-19 associated with mucormycosis in the setting of corticosteroid use and diabetes as potential predisposing factors have been reported in India.1

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Article Information

Corresponding Author: Ashish Sharma, MD, Lotus Eye Hospital and Institute, Avinashi Road, Civil Aerodrome Post, Peelamedu, Coimbatore, Tamil Nadu 641014 India (drashish79@hotmail.com).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Sohan Singh Hayreh, MD, MS, PhD, DSc, University of Iowa, for helping us understand the pathophysiology of this case in the light of his extensive clinical and experimental experience in this field. He was not compensated for his contributions. We also thank the patient for granting permission to publish this information.

References
1.
Sen  M, Honavar  SG, Bansal  R,  et al; Members of the Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC) Study Group.  Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India— collaborative OPAI-IJO study on mucormycosis in COVID-19 (COSMIC), report 1.   Indian J Ophthalmol. 2021;69(7):1670-1692. doi:10.4103/ijo.IJO_1565_21PubMedGoogle ScholarCrossref
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