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Abdulkader RS, Ponnaiah M, Bhatnagar T, S D, Rozario AG, K G, Mohan M, E M, Saravanakumar D, Moorthy A, Tyagi AK, Parmar BD, Devaraja K, Medikeri G, Ojah J, Srivastava K, K K, Das N, B N, Sharma P, Kumar Parida P, Kumar Saravanam P, Kulkarni P, S P, Patil S P, Kumar Bagla R, D R, S Melkundi R, S Satpute S, Narayanan S, Jahagirdar S, Dube S, Kumar Panigrahi S, Babu D S, Saini V, Singh Saxena R, Srivastava A, Chandra Baishya A, Garg A, Kumar Mishra A, Jyoti Talukdar A, Kankaria A, Karat A, Sundaresh Kumar A, Chug A, Vankundre A, Ramaswamy B, MB B, R Jadav B, Dhiwakar M, Ghate G, Shah HV, Saha I, Sivapuram K, J Joshi K, Singh M, Chand Bairwa M, K D, K K, E M, Samagh N, Dinakaran N, Gupta N, Gupta N, M Nagarkar N, Solanki N, Kumar Panda P, Bachalli P, Shanbag R, Patil R, Kumar A R, Narayan Patil R, Thookkanaickenpalayam Vijayaraghavan R, Hanumantappa R, A R, Mandal SK, Kishve SP, Varghese Thomas S, Sarkar S, Thakur S, Patil S, Lakshmanan S, D Rao S, V S, Nayak T, Dixit UR, B U, Backiavathy V, Shenoy V, Hallur VK, Bhatnagar A, Murhekar MV. Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India. Mycology 2024; 15:70-84. [PMID: 38558844 PMCID: PMC10976993 DOI: 10.1080/21501203.2023.2271928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.
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Affiliation(s)
| | | | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Devika S
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Gayathri K
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malu Mohan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Michaelraj E
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Aditya Moorthy
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhagirathsinh D Parmar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - K Devaraja
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gaurav Medikeri
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Jutika Ojah
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Kajal Srivastava
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nandini Das
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Niharika B
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Parul Sharma
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Pradipta Kumar Parida
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Prasanna Kumar Saravanam
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Priya S
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Pushpa Patil S
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rahul Kumar Bagla
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Ramesh D
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Renuka S Melkundi
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Satish S Satpute
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shubhashri Jahagirdar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Simmi Dube
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Panigrahi
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Surendra Babu D
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
| | - Vaibhav Saini
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rita Singh Saxena
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Abhinav Srivastava
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | | | - Ajai Garg
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Amit Kumar Mishra
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Anjan Jyoti Talukdar
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Ankita Kankaria
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Arathi Karat
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
| | - Arul Sundaresh Kumar
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Ashi Chug
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Vankundre
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharathi MB
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Bhargav R Jadav
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - Muthuswamy Dhiwakar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Girija Ghate
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Hardik V Shah
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Ipsita Saha
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Kavya Sivapuram
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Krupal J Joshi
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Mahendra Singh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Chand Bairwa
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Muthurajesh E
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Navneh Samagh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Nethra Dinakaran
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Nikhil Gupta
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Nitin Gupta
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nitin M Nagarkar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Nitin Solanki
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Prasan Kumar Panda
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prithvi Bachalli
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Raghunath Shanbag
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rajashri Patil
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Rajesh Kumar A
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Rakesh Narayan Patil
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | | | - Ramesh Hanumantappa
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Rathinavel A
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Saleel Kumar Mandal
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Sara Varghese Thomas
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Shalini Thakur
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Siddaram Patil
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Somu Lakshmanan
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Srinivas D Rao
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Sumathi V
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Tulasi Nayak
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Umesh R Dixit
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Backiavathy
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Vijendra Shenoy
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vinay Kumar Hallur
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
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Vasanthapuram VH, Gupta R, Adulkar N, Nair AG, Bradoo RA, Hegde R, Singh U, Tadepalli S, Mukherjee B, Kamal S, Alam MS, Rao R, Ananthakrishna S, Backiavathy V, Murthy AK, D'Cunha L, Dudeja G, Joji A, Kiran A, Koka K, Goswami Mukhopadhyay M, Nisar SP, Rao PR, Shinde CA. A fungal epidemic amidst a viral pandemic: Risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis in India. Orbit 2023; 42:30-41. [PMID: 35192435 DOI: 10.1080/01676830.2021.2020851] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. METHODS Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed. RESULTS There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years (p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 (p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect (p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease. CONCLUSION Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.
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Affiliation(s)
| | - Roshmi Gupta
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Namrata Adulkar
- Orbit & Oculoplasty Services, Sunayan Eye Care and Aesthetic Clinic, Pune, India
| | - Akshay Gopinathan Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India.,Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital & institute, Advanced Eye Hospital & Institute, Navi Mumbai India.,Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Renuka A Bradoo
- Department of ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Raghuraj Hegde
- Orbit, Ophthalmic Plastic Surgery & Ophthalmic Oncology Service, Department of Ophthalmology, Manipal Hospital, Bangalore, India
| | - Usha Singh
- Department of Ophthalmic Plastic Surgery, Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Sameeksha Tadepalli
- Department of Ophthalmic Plastic Surgery, Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Saurabh Kamal
- Orbit & Oculoplasty Services, EYEHUB, Faridabad, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Raksha Rao
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | | | - Varsha Backiavathy
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | | | - Lynn D'Cunha
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Gagan Dudeja
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Annie Joji
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Anjali Kiran
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Kirti Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | | | - Sonam Poonam Nisar
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Priyanka R Rao
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Chhaya A Shinde
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
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