Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis
Rhino-orbital cerebral mucor mycosis is a rare disease entity, where retinal involvement is described in the literature mostly as CRAO. However, pathological studies have shown mucor invading the choroid and retina with a neutrophilic reaction. So, it is pertinent that retinal inflammation secondary...
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MDPI AG
2022-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/12/3098 |
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| author | Ankur Singh Preeti Diwaker Akanksha Agrawal Aniruddha Agarwal Jolly Rohatgi Ramandeep Singh Gopal Krushna Das Pramod Kumar Sahoo Vinod Kumar Arora |
| author_facet | Ankur Singh Preeti Diwaker Akanksha Agrawal Aniruddha Agarwal Jolly Rohatgi Ramandeep Singh Gopal Krushna Das Pramod Kumar Sahoo Vinod Kumar Arora |
| author_sort | Ankur Singh |
| collection | DOAJ |
| description | Rhino-orbital cerebral mucor mycosis is a rare disease entity, where retinal involvement is described in the literature mostly as CRAO. However, pathological studies have shown mucor invading the choroid and retina with a neutrophilic reaction. So, it is pertinent that retinal inflammation secondary to invading mucor has some role in microstructural changes seen in the vitreous and retina of these patients. This novel study aims to describe the vitreal and retinal features of patients with vision-threatening rhino-orbital cerebral mucor mycosis and how they evolve on spectral domain optical coherence tomography (SD-OCT). This study shall also provide insight into the pathophysiology of these vitreoretinal manifestations by in vitro analysis of the exenterated orbital content. Fifteen eyes of fifteen patients with vision-threatening ROCM treated with standard care were enrolled in this study and underwent complete ophthalmic examination, serial colour fundus photography, and SD-OCT for both qualitative and quantitative analysis, at baseline and follow-up visits. SD-OCT on serial follow-up revealed thickening and increased inner-retinal reflectivity at presentation followed by thinning of both, other features such as the loss of the inner-retinal organized layer structure, external limiting membrane (ELM) disruption, necrotic spaces in the outer retina, and hyperreflective foci. Vitreous cells with vitreous haze were also seen. There was a significant reduction in CMT, inner and outer retinal thickness, total retinal thickness (all <i>p</i> < 0.05) with time, the quantum of reduction concentrated primarily to the inner retina. In summary, in vivo and in vitro analysis revealed that early microstructural changes were primarily a result of retinal infarctions secondary to thrombotic angioinvasion. With the late microstructural changes, there was possible sequelae of retinal infarction with some contribution from the inflammation, resulting from mucor invading the choroid and retina. |
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| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T17:08:28Z |
| publishDate | 2022-12-01 |
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| series | Diagnostics |
| spelling | doaj.art-8cf5ded6c5bb42a88f02418d5a3c03a52023-11-24T14:18:37ZengMDPI AGDiagnostics2075-44182022-12-011212309810.3390/diagnostics12123098Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective AnalysisAnkur Singh0Preeti Diwaker1Akanksha Agrawal2Aniruddha Agarwal3Jolly Rohatgi4Ramandeep Singh5Gopal Krushna Das6Pramod Kumar Sahoo7Vinod Kumar Arora8Department of Ophthalmology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaDepartment of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaDepartment of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaCleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Ophthalmology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaVitreoretina and Uveitis Service, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, IndiaDepartment of Ophthalmology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaDepartment of Ophthalmology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaDepartment of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, IndiaRhino-orbital cerebral mucor mycosis is a rare disease entity, where retinal involvement is described in the literature mostly as CRAO. However, pathological studies have shown mucor invading the choroid and retina with a neutrophilic reaction. So, it is pertinent that retinal inflammation secondary to invading mucor has some role in microstructural changes seen in the vitreous and retina of these patients. This novel study aims to describe the vitreal and retinal features of patients with vision-threatening rhino-orbital cerebral mucor mycosis and how they evolve on spectral domain optical coherence tomography (SD-OCT). This study shall also provide insight into the pathophysiology of these vitreoretinal manifestations by in vitro analysis of the exenterated orbital content. Fifteen eyes of fifteen patients with vision-threatening ROCM treated with standard care were enrolled in this study and underwent complete ophthalmic examination, serial colour fundus photography, and SD-OCT for both qualitative and quantitative analysis, at baseline and follow-up visits. SD-OCT on serial follow-up revealed thickening and increased inner-retinal reflectivity at presentation followed by thinning of both, other features such as the loss of the inner-retinal organized layer structure, external limiting membrane (ELM) disruption, necrotic spaces in the outer retina, and hyperreflective foci. Vitreous cells with vitreous haze were also seen. There was a significant reduction in CMT, inner and outer retinal thickness, total retinal thickness (all <i>p</i> < 0.05) with time, the quantum of reduction concentrated primarily to the inner retina. In summary, in vivo and in vitro analysis revealed that early microstructural changes were primarily a result of retinal infarctions secondary to thrombotic angioinvasion. With the late microstructural changes, there was possible sequelae of retinal infarction with some contribution from the inflammation, resulting from mucor invading the choroid and retina.https://www.mdpi.com/2075-4418/12/12/3098rhino-orbital mucormycosisoptical coherence tomographyretinitiscentral retinal artery occlusionophthalmic artery occlusiondisruption of retinal layers |
| spellingShingle | Ankur Singh Preeti Diwaker Akanksha Agrawal Aniruddha Agarwal Jolly Rohatgi Ramandeep Singh Gopal Krushna Das Pramod Kumar Sahoo Vinod Kumar Arora Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis Diagnostics rhino-orbital mucormycosis optical coherence tomography retinitis central retinal artery occlusion ophthalmic artery occlusion disruption of retinal layers |
| title | Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis |
| title_full | Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis |
| title_fullStr | Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis |
| title_full_unstemmed | Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis |
| title_short | Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis |
| title_sort | spectral domain optical coherence tomography findings in vision threatening rhino orbital cerebral mucor mycosis a prospective analysis |
| topic | rhino-orbital mucormycosis optical coherence tomography retinitis central retinal artery occlusion ophthalmic artery occlusion disruption of retinal layers |
| url | https://www.mdpi.com/2075-4418/12/12/3098 |
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