PMC6915154_01
Case 1, fundus photography showed obstruction of the central artery of the retina (cherry red spot (arrow)) and posterior pole edema affecting right eye.
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In the ophthalmological assessment visual acuity of the RE was nonperception of light (NPL); in the fundus there was macular and posterior pole edema with cherry red spot, and reduction of the vascular caliber with sharp arteries and segmentation of blood flow (Figure 1).
Case 1, computed tomography (CT) with partial occupation of right ethmoidal cells and right sphenoid sinus.
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A computed tomography (CT) was requested in which a partial occupation of right ethmoidal cells and right sphenoid sinus was observed (Figure 2).
Case 1, magnetic resonance with right ethmoid and sphenoid occupation with increased compared to previous CT (Figure 2).
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A magnetic resonance (MR) was performed, which showed right ethmoid and sphenoid occupation with increased density compared to the previous CT, but with no signs of invasion (Figures 3(a) and 3(b)).
Case 1 (a) urgent surgical intervention with total exenteration of the right orbit (b) (c) (d) orbital cavity exenteration what the surgical bed shows.
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Suspecting ROC mucormycosis, total orbital exenteration was performed, including the skin of the eyelids, in which necrosis of the medial wall and orbital floor was found, so a broad debridement was performed (Figures 4(a)-4(d)).
Case 1 pathological study (a) and (b), pathological examination showed abundant wide mycelia (arrow), nonseptate, some of them partitioned, that were arranged angiocentrically, destroying and invading the vascular walls. (a) Hematoxylin&Eosin stain, original magnification x 10, 100 mum scale lower right. (b) Hematoxylin&Eosin stain, original magnification x 20, 50 mum scale lower right. There were fungal microabscesses with necrotic center in periphery (b) (asterisk).
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There were fungal microabscesses with necrotic center in periphery (asterisk) (Figures 5(a) and 5(b)).
Case 1 (a) reconstructive surgery, (a) temporal cutaneous marking of the right orbital exenteration with a temporal muscle flap (b) (arrow) through a modified lateral orbitotomy (bone window in the lateral wall maintaining the external part of the frontal malar apophysis (c) and (d) (arrow). Initial to mid-stage surgery.
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At the first postoperative month, thanks to the recovery of immunosuppression of the patient and the good clinical evolution, the reconstruction of the orbital exenteration defect was performed with a temporal muscle flap and a skin island pedicled flap, and a titanium mesh implant in medial and lower region (Figures 6(a)-6(d) and 7(a)-7(d)).
Case 1 (a) and (b) clinical aspect of the patient 2-weeks after reconstruction surgery.
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Postoperative images two weeks after the reconstruction (Figures 8(a) and 8(b)) and after 6 months (Figures 9(a) and 9(b)) are shown.
Case 1 (a) and (b) clinical aspect of the patient 6-months after reconstructive surgery.
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Postoperative images two weeks after the reconstruction (Figures 8(a) and 8(b)) and after 6 months (Figures 9(a) and 9(b)) are shown.
PMC6915154_02
Case 2 (a) and (b) 7-days after postsurgery of right orbital total exenteration.
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Immediate intravenous treatment was established, following the same pattern as in the previous case, and total orbital exenteration with maxillectomy was performed (Figures 10(a) and 10(b)), keeping part of the orbital floor, complete ethmoidectomy and sphenoidectomy with opening of lateral recess, frontal sinus opening by external approach and resection of hard hemipaladar.
Case 2 (a) pathological study showed a respiratory epithelium (pseudostratified ciliated) (arrow). In the underlying chorionnonseptate hyphae associated with an acute neutrophilic infiltrate were identified, Hematoxilin&Eosin, original magnification x 20 (50 mum scale lower right). In (b) associated nonseptate hyphae (arrow) and a neutrophilic inflammatory infiltrate appear around a nerve (asterisk) Hematoxylin&Eosin, original magnification x 20 (50 mum scale lower right) and in (c) there are also nonseptate hyphae (arrow), cellular debris and a neutrophilic infiltrate that destroys the wall of a blood vessel, Hematoxylin&Eosin stain, original magnification x 20 (50 mum scale lower right).
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In the underlying chorion, nonseptate hyphae associated with an acute neutrophilic infiltrate were identified (Figure 11(a)). In (Figure 11(b)) associated nonseptate hyphae (arrow) and a neutrophilic inflammatory infiltrate appear around a nerve (asterisk). And in (Figure 11(c)) there are also nonseptate hyphae (arrow), cellular debris and a neutrophilic infiltrate that destroys the wall of a blood vessel.