SARS-CoV-2, which causes the clinical disease COVID-19, has now affected more than 200 million patients worldwide with close to 5 million deaths.¹ Ophthalmic manifestations of COVID-19 are wide-ranging and present in up to 10% of patients, most commonly as conjunctivitis.² The enormous number and high acuity of infected patients have placed significant burdens on health care systems worldwide. The resulting deferral of medical care for other life-threatening conditions such as cancer and heart disease may lead to additional morbidity and mortality.

In this issue of JAMA Ophthalmology, Choksi et al³ join other authors in focusing our attention on another potentially lethal complication of SARS-CoV-2 infection, rhino-orbital-cerebral mucormycosis (ROCM) associated with COVID-19, that is, COVID-19–associated mucormycosis (CAM). Prior to the pandemic, mucormycosis was considered a rare disease, with an incidence of 0.005 to 1.7/million.⁴ Fewer than 10 cases are encountered annually at Mayo Clinic Rochester (N. Wengenack, PhD, oral communication, October 15, 2021). The current series, by contrast, includes 73 cases of CAM treated over a 3-month period. The authors’ experience confirms the massive increase in ROCM cases in India associated with COVID-19, with more than 15 000 cases as of May 2021.⁵

Hematological malignancy, diabetes, pharmacological immunosuppression, high-dose steroid therapy, and HIV infection are well-established risk factors for ROCM.⁴ In this study, the main risk factors for CAM were diabetes and steroid use. Three-quarters of patients had diabetes, with more than half with disease characterized as uncontrolled. More than 80% received steroids, either intravenous (IV) or oral, to offset the massive cytokine response driving COVID-19–related pneumonitis and acute respiratory distress syndrome. Supplemental oxygen or ventilatory support was required in 82% of patients. Vaccine information was available for 47 patients, of whom 89% were unvaccinated and none were fully vaccinated.

导致临床疾病 COVID-19 的 SARS-CoV-2 现已影响全球 2 亿多名患者，近 500 万人死亡。¹ COVID-19 的眼科表现范围广泛，最多见于 10% 的患者，最常见的是结膜炎。²受感染患者的数量庞大且病情严重，给全世界的医疗保健系统带来了沉重的负担。由此导致的对其他危及生命的疾病（如癌症和心脏病）的医疗护理延迟可能会导致额外的发病率和死亡率。

在本期JAMA Ophthalmology中，Choksi 等人³与其他作者一起将注意力集中在 SARS-CoV-2 感染的另一种潜在致命并发症，即与 COVID-19 相关的鼻-眶-脑毛霉菌病 (ROCM)，即 COVID -19 相关毛霉菌病 (CAM)。在大流行之前，毛霉菌病被认为是一种罕见病，发病率为 0.005 至 1.7/百万。⁴ Mayo Clinic Rochester 每年遇到的病例少于 10 例（N. Wengenack，博士，口头交流，2021 年 10 月 15 日）。相比之下，目前的系列包括 3 个月内治疗的 73 例 CAM。作者的经验证实，印度与 COVID-19 相关的 ROCM 病例大量增加，截至 2021 年 5 月已超过 15000 例。⁵

血液系统恶性肿瘤、糖尿病、药物免疫抑制、大剂量类固醇治疗和 HIV 感染是 ROCM 的公认危险因素。⁴在这项研究中，CAM 的主要危险因素是糖尿病和类固醇的使用。四分之三的患者患有糖尿病，超过一半的患者病情不受控制。超过 80% 的人接受了静脉注射 (IV) 或口服类固醇，以抵消导致 COVID-19 相关肺炎和急性呼吸窘迫综合征的大量细胞因子反应。82% 的患者需要补充氧气或通气支持。有 47 名患者的疫苗信息可用，其中 89% 未接种疫苗，没有人完全接种疫苗。