Prognostic factors and our results in rhino-orbital mucormycosis cases

Purpose: To determine the frequency of patients' and vision survival, prognostic factors and also to evaluate clinical features and treatment responses in cases of orbital mucormycosis. Materials and Methods: Forty-three eyes of 43 patients followed up with orbital mucormycosis infection were included in the study. Demographic characteristics of the patients, symptoms at admission, ophthalmological and non-ophthalmological examination findings, laboratory results, clinical findings during follow-up, radiological imaging, medical and surgical procedures and complications were recorded. Patients' survival was defined according to the frequency of death and vision survival according to the frequency of light sensation (perception) loss. Results: Twenty-seven (62.8%) patients were male and 16 (37.2%) were female. The mean age of the patients was 47.6±20.1 (1-76). When the underlying disease status of the patients was examined, it was observed that all patients had an underlying disease and diabetes constituted the majority of them (65.2%). Periorbital swelling (69.8%), ophthalmoplegia (53.5%) and vision loss (46.5%) were the most common symptoms and findings at admission of patients with mucormycosis infection. The mean follow-up period was 5±6.7 (0.3-33) months. The disease resulted in death in 22 (51.2%) of the patients. In 9 (52.9%) of 17 patients who were alive and did not undergo exenteration operation, visual acuity was at least at the level of perception and there was vision survival. Presence of fever and shorter duration of antifungal therapy were associated with lower patient survival (p=0.046, p<0.001). Exenteration operation was not found to be associated with the survival of the patients. Frozen eye, loss of light reflex, and development of central retinal artery occlusion were also associated with lower vision survival (p=0.002, p=0.009, p=0.029). Conclusion: Mucormycosis is a disease with acute onset, aggressive course and high mortality rate, characterized by vascular invasion and tissue necrosis. Our study presents one of the largest patient series in the literature on this disease. Knowing the symptoms of the patients at the time of admission and the clinical findings during the infection process will increase awareness about the disease. We think that the prognostic markers which were identified in the study will be a guide both in the treatment and follow-up phase of the disease and in future studies.