Comparative Analysis of Outcomes and Influencing Factors in COVID-Associated Rhino-Orbital-Cerebral Mucormycosis: Globe Salvage Versus Exenteration

Aim This study aimed to evaluate and compare the outcomes of globe-salvaging procedures versus orbital exenteration in patients with COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) during the second wave of the pandemic in India. Methods An ambispective observational study was conducted at a tertiary care hospital in Central India between April and October 2021. Thirty-five consecutive patients with confirmed ROCM and recent COVID-19 infection were enrolled. Based on the extent of orbital involvement and surgical judgment, patients were categorized into either the Globe Salvage Group or the Exenteration Group. Clinical characteristics, comorbidities, treatment details, and outcomes were recorded, with a minimum follow-up of six months. The primary outcome was survival; secondary outcomes included disease recurrence, disease control, and postoperative complications. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, USA). This study adheres to the STrengthening the Reporting of OBservational studies in Epidemiology(STROBE) guidelines. Results The mean age of patients was 48.77 years, and 82.9% were male. Diabetes and prior corticosteroid use were present in 82.9% of patients. All cases were advanced ROCM (Stage III/IV). Of the 35 patients, 25 (71.4%) underwent globe-salvaging procedures, while 10 (28.6%) underwent orbital exenteration. Overall survival was 82.9%, with higher mortality in the Exenteration Group (40%) compared with the salvage group (8%). Disease recurrence occurred in 10% of the salvage group and 5% of the Exenteration Group. Conclusions When carefully selected, globe-salvaging procedures provide survival outcomes comparable to exenteration, with lower morbidity. Early diagnosis, control of risk factors, and timely intervention are essential to improving outcomes in ROCM.