key: cord-0762644-13h8tspc authors: Nair, Akshay Gopinathan title: Commentary: COVID-19-associated mucormycosis: The ongoing battle date: 2021-12-03 journal: Indian J Ophthalmol DOI: 10.4103/ijo.ijo_2789_21 sha: 980bf55f051f0eea5707badb3dfe4a6043f3d94f doc_id: 762644 cord_uid: 13h8tspc nan Vare et al. in their manuscript reported the incidence, cumulative mortality, and factors affecting the outcome of COVID-19-associated mucormycosis (CAM) from western India. The reported incidence of CAM in this report, that is, 13.6 cases per 1000 cases of moderate-severe COVID-19 infection, is a debatable figure as the paper does not specify if the 67 CAM patients belonged to the same pool of the 4910 COVID-19 patients treated at the same hospital. In this series, the minimum follow-up period was 1 month, and the mean follow-up period was 35 ± 2.7 days. This follow-up period is not long enough to draw reliable conclusions, and monitoring is needed over longer periods of time to know the eventual outcomes. Other events such as late sequelae or disease recurrence are seen later on in the course of the disease and may be missed if the follow-up period is too short. Mortality rates, recovery rates, and other data on factors predicting outcomes cannot be ascertained from such short follow-up periods; especially when the recommended duration of medical therapy itself is at least 6 months. [1] Transcutaneous retrobulbar amphotericin-B injection (TRAMB) has proven to be a game-changer in the treatment of orbital mucormycosis. [2, 3] However, this technique was not employed by the authors in the treatment of CAM in their patients. It is possible that the rates of orbital exenteration amongst CAM patients could have been reduced if TRAMB had been instituted in suitable patients early on in the course of treatment. This paper also reports that the cumulative probability of death or orbital exenteration was 38% at day 20 of infection. Furthermore, it mentions that those who required NIV and did not receive amphotericin-B were at a high risk of these outcomes. Requirement of non-invasive ventilation is more likely a surrogate measure of the COVID-19 severity. It is alarming to note that there were patients in this cohort who despite having a confirmed diagnosis of mucormycosis were unable to receive the drug of choice (amphotericin-B), most likely due to unavailability of the drug. One of the highlights of this paper is that it brings forth the mortality and morbidity due to CAM when amphotericin-B was not available. This is crucial data that focuses on the need for an emergency stockpile of essential drugs such as amphotericin-B-data that all stakeholders and policymakers need to bear in mind to avert a potentially avoidable catastrophe in the future. Post-COVID-19 opportunistic candida retinitis: A case report A case series of presumed fungal endogenous endophthalmitis in post-COVID-19 patients Fungal co-infections associated with global COVID-19 pandemic: A clinical and diagnostic perspective from China Mucor in a viral land: A tale of two pathogens Rise of the phoenix: Mucormycosis in COVID-19 times Rhinocerebral mucormycosis and COVID-19 pneumonia Coronavirus disease (COVID-19) associated mucormycosis (CAM): Case report and systematic review of literature Sino-orbital mucormycosis in a COVID-19 patient: A case report Rhino-orbital mucormycosis associated with COVID-19 Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? COVID-19 and mucormycosis of the craniofacial skeleton: Causal, contributory or coincidental? A Case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19 Mucormycosis with orbital compartment syndrome in a patient with COVID-19 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 Clinical presentations, management and outcomes of rhino-orbital-cerebral mucormycosis (ROCM) following COVID-19: A multi-centric study Rhino-orbital mucormycosis following COVID-19 in previously non-diabetic, immunocompetent patients Code mucor: Guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19 Rhino-orbito-cerebral mucormycosis -Guidelines for diagnosis, staging, and management Outcomes of a modified treatment ladder algorithm using retrobulbar amphotericin B for invasive fungal rhino-orbital sinusitis Transcutaneous retrobulbar injection of amphotericin B in rhino-orbital-cerebral mucormycosis: A review The authors are to be commended for this work and are strongly encouraged to follow up with the patients included in this study for a longer period to obtain more meaningful data on long-term outcomes. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.