key: cord-0752498-rzo6v5sm
authors: Kochar, Shruti; Lahane, Sumeet; Thomas, Rwituja; Khare, Shalini
title: Histopathological evidence of central retinal artery occlusion secondary to angio-invasive fungal infection amidst SARS-CoV-2 pandemic
date: 2021-09-25
journal: Indian J Ophthalmol
DOI: 10.4103/ijo.ijo_1127_21
sha: efb745689c97d2cebf218b2c0c8358e8388ae60b
doc_id: 752498
cord_uid: rzo6v5sm

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Rhino-orbital-cerebral mucormycosis (ROCM) can present in various forms, the most common being ophthalmoplegia, with or without central retinal artery occlusion (CRAO). [1] [2] [3] Patients with minimal to no evidence of orbital involvement by fungus on imaging also develop restrictions of ocular movement in all gazes. Lesions causing ophthalmoplegia usually involve the orbital apex and/or the cavernous sinus. Mucor has a tendency for angioinvasion leading to thrombosis of blood vessels and resultant tissue necrosis. [4] A 64-year-old diabetic gentleman presented to us with loss of vision, absent ocular motility, and ptosis in the right eye after having recovered from COVID-19 infection 3 weeks prior [ Fig. 1a ]. He was noted to have CRAO in the right eye [ Fig. 1b] . He was subsequently diagnosed with ROCM and underwent right orbital exenteration due to worsening. Despite minimal cellulitis secondary to orbital apex involvement, the muscular arteries were invaded by fungus with aseptate hyphae (as noted on histopathological examination), leading to ophthalmoplegia and ptosis. Histopathological (HPE) analysis of the right optic nerve stump of the exenterated specimen in our patient with ophthalmoplegia and CRAO revealed occlusion of the central retinal artery secondary to invasion of its muscular coat by a fungus with aseptate hyphae [ Fig. 1c and d] . Endothelial cell damage and activation of coagulation cascade is the key pathophysiological mechanism for thrombus formation. [4, 5] To the best of our knowledge, this is the first reported direct histopathological evidence of angioinvasion of the central retinal artery by Mucorales species leading to vision loss in a case of ROCM.

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Nil.

There are no conflicts of interest.

Survival factors in rhino-orbital-cerebral mucormycosis

Indications for orbital exenteration in mucormycosis

Central retinal artery occlusion as the presenting manifestation of invasive rhino-orbital-cerebral mucormycosis

Pathogenesis of mucormycosis

Rhinocerebral mucormycosis: Pathways of spread

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