影像隐匿性蝶窦真菌感染所致眶尖综合征及早期手术探查的必要性：一项回顾性病例系列研究
Orbital apex syndrome caused by imaging-occult sphenoid sinus fungal infection and the necessity of early surgical exploration: a retrospective case series.
文献信息
| PMID | 42968036 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Zhixing Li |
| 作者单位 | State Key Laboratory of Eye Health, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China. |
| 期刊 | BMC ophthalmology |
| SCI 分区 | Q3 |
| IF | 2.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 描述一种以急性眶尖综合征（OAS）为表现、缺乏典型侵袭性影像学征象的高度隐匿性蝶窦侵袭性真菌性鼻窦炎（IFRS）亚型，并评估早期手术干预的疗效。
方法： 本回顾性病例系列评估了6例（2021年3月至2025年11月）影像学表现严格轻微但仍继发蝶窦IFRS并出现典型OAS的患者。所有患者均接受导航引导下内镜下鼻窦清理及视神经减压术。分析术前和术后神经眼科参数（最佳矫正视力[BCVA]、视野指数[VFI]、平均偏差[MD]及眼球运动）。计算偏倚校正效应量（Hedges' g）以量化功能恢复程度。
结果： 病理评估证实为烟曲霉（n=4）、青霉（n=1）和少根根霉（n=1）。4例患者（66.7%）合并2型糖尿病。手术后，BCVA中位数从1.91改善至0.30 LogMAR（Hedges' g = 0.80）。在完成视野检查的4例患者中，VFI中位数从11%改善至91.5%（g = 1.37），MD中位数从-28.02改善至-3.33 dB（g = 1.23）。3例眼球运动受累患者中2例完全恢复。值得注意的是，2例视力未恢复的患者术前存在严重高血糖（>14 mmol/L）。未发生严重手术相关并发症。
结论： 对于表现为这种显著“临床-影像分离”的隐匿性IFRS，早期导航引导下内镜探查是挽救视力的关键策略。严格控制血糖对于维持这一治疗窗口至关重要。尚需进一步的前瞻性验证。
英文摘要
OBJECTIVE: To characterize a highly occult subtype of sphenoid invasive fungal rhinosinusitis (IFRS) presenting as acute orbital apex syndrome (OAS) without classic invasive imaging signs, and to evaluate the efficacy of early surgical intervention.
METHODS: This retrospective case series evaluated six patients (March 2021-November 2025) who developed classic OAS secondary to sphenoid IFRS despite strictly subtle imaging manifestations. All underwent navigation-guided endoscopic sinus clearance and optic nerve decompression. Pre- and postoperative neuro-ophthalmic parameters (best-corrected visual acuity [BCVA], visual field index [VFI], mean deviation [MD], and ocular motility) were analyzed. Bias-corrected effect sizes (Hedges' g) were calculated to quantify the magnitude of functional recovery.
RESULTS: Pathological evaluation confirmed Aspergillus fumigatus (n=4), Penicillium citrinum (n=1), and Rhizopus oryzae (n=1). Four patients (66.7%) had comorbid type 2 diabetes. Following surgery, median BCVA improved from 1.91 to 0.30 LogMAR (Hedges' g = 0.80). In the four patients completing visual field testing, median VFI improved from 11% to 91.5% (g = 1.37), and median MD improved from -28.02 to -3.33 dB (g = 1.23). Ocular motility fully recovered in two of three affected patients. Notably, the two patients lacking visual recovery presented with severe preoperative hyperglycemia (>14 mmol/L). No severe surgery-related complications occurred.
CONCLUSIONS: For occult IFRS presenting with this striking 'clinical-radiological dissociation', early navigation-guided endoscopic exploration is a crucial sight-saving strategy. Strict glycemic control is paramount to preserving this therapeutic window. Further prospective validation is warranted.