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PURPOSE: The purpose of this study was to determine the role of transcutaneous retrobulbar amphotericin B (TRAMB) injection in COVID-19-related rhino-orbital-cerebral mucormycosis (ROCM). MATERIALS AND METHODS: This prospective interventional case series included 7 eyes of 7 patients diagnosed with COVID-19 ROCM presenting from May to September 2021 at a tertiary care center in North India. Active or recovered cases of COVID-19 with clinical features suggestive of ROCM and early orbital involvement were included. Following functional endoscopic sinus surgery, patients were given TRAMB 3.5 mg/ml in single ocular quadrant depending upon the muscle involved on contrast-enhanced magnetic resonance imaging (MRI). Patients were followed up for a period of 12 weeks. RESULTS: All patients were diabetic and COVID-19 reverse transcription-polymerase chain reaction positive. The mean age of patients was 48.4 years ± 11 years, out of which 5 patients were male and 2 were female. The left eye was involved in 57.14% of cases whereas 42.85% of cases had right eye involvement. Presenting complaints were drooping of the upper lid (57.14%; n = 4), proptosis (28.57%; n = 2), facial pain and swelling (85.71%; n = 6), and nasal block (57.14%; n = 4). Stagewise distribution was 3a in four patients (57.14%), 3b in two patients (28.57%), and 4a in one patient. TRAMB injections (median - 3) were given, and improvement was seen in all patients in terms of ocular movements, ptosis, proptosis, and muscle enhancement on MRI scan. Three patients had an increase in intraocular pressure and inflammation which settled within a week with favorable anatomical and functional outcomes. CONCLUSION: Transcutaneous retrobulbar amphotericin B should be considered an adjunctive treatment modality for ROCM patients with limited orbital disease to preserve ocular function. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.Methods: A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.Results: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.Conclusion: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation. [ABSTRACT FROM AUTHOR]

Aim: We report a series of orbital sarcoid in a south Indian patient population and their outcome.Materials & Methods: Retrospective interventional case series.Results: Eleven out of 144cases of biopsy-proven sarcoidosis had orbital involvement. The mean age was 50.64 ± 9.52years and was more commonly seen in women (90.91%). Unilateral presentation with right orbit involvement was more common. Bilateral lacrimal gland enlargement (4cases), inferior orbital mass presenting as proptosis (4cases), preseptal mass above upper eyelid (2cases) and orbital mass encasing the globe (1case) were the different types of orbital presentation. All cases had a dry eye and a negative mantoux test. CT thorax was abnormal in 7cases (63.61%). Biopsy in all cases showed noncaseating granulomatous inflammation. Oral steroids were the standard mode of treatment and none of the cases had recurrences.Conclusions: Orbital sarcoidosis is seen in a high TB endemic country like India and is definitely underreported. [ABSTRACT FROM AUTHOR]

Objectives: The morphology and anatomical relationship of periorbital features vary according to age, sex and ethnicity. Standard database regarding periorbital region is available for other ethnic groups. Since there is no data available in the literature, specifically for south Indian ethnic adults, the present study was carried out to determine the normal average values for South Indian ethnic population related to gender. Methods: Anthropometric measurements of both eyes were done on standardized frontal view photograph of 200 South Indian ethnic adults aged 18 to 26 years. Parameters included were palpebral fissure width (PFW), palpebral fissure height (PFH), palpebral fissure inclination (PFI), outercanthal distance (OCD), interpupillary distance (IPD), intercanthal distance (ICD) and comparisons were made between the genders using the independent t test. Results: Significant sexual dimorphism was noted in the given parameters. Palpebral fissure width (male: 31.08 mm; female: 29.90 mm), palpebral fissure inclination (male: 5.053°; female: 6.102°), outercanthal distance (male: 95.55 mm; female: 92.44 mm) and interpupillary distance (male: 66.72 mm; female: 62.59 mm). The palpebral fissure height (male: 11.30 mm; female: 11.58 mm) and intercanthal distance (male: 34.27 mm; female: 33.41 mm) showed no significant sexual differences. Conclusion: Statistically significant differences were found between South Indian ethnic males and female in certain key parameters. The present study suggests that ethnicity and gender should be considered in orbital surgery. To individualize the treatment planning and diagnosis, it is important for the surgeons to have knowledge of these local norms. [ABSTRACT FROM AUTHOR]

Abstract: Our understanding of monsoon circulation timing’s at the orbital scale is currently a matter of debate. Here, we compare previous and recently published results of Indian, East Asian, West African and East African monsoon variability. We note different timings between the East African, West African, Indian and East-Asian monsoon systems for the most recent 45 ka, where the age models are constrained by AMS dating. On this basis, we construct different orbital forcing “reference curves” and apply them to the 200 ka time period for the different monsoon systems. Our results indicate that the ‘global monsoon’ concept at the orbital scale is a misnomer. We find real regional differences in the timing of the monsoon response to orbital forcing and differences in the weight of precession and obliquity in the monsoon records. This work highlights the necessity of studies aimed at understanding the underlying physics of these regional response patterns. This is crucial to a better understanding of monsoon dynamics and improved climate model simulations and comparisons with proxy data. [Copyright &y& Elsevier]