摘要
目的观察真菌性蝶窦炎所致视觉功能损伤患者的临床特征,初步分析其与视力预后相关的影响因素。方法回顾性临床研究。2006年1月至2020年12月于北京同仁医院眼科经影像学和病理检查确诊的真菌性蝶窦炎致视觉功能损伤患者44例55只眼纳入研究。所有患者均因单眼或双眼视力下降,或双眼复视、眼球运动受限、上睑下垂首诊于眼科。患者均行视力、眼底彩色照相检查。同时行鼻窦或眼眶CT检查37例,副鼻窦、颅脑或眼眶磁共振成像(MRI)检查34例。患者均行鼻内镜下鼻窦开放联合窦内病灶清除手术;手术后行抗真菌药物治疗14例。手术后平均随访时间(59.61±37.70)个月。侵袭性、非侵袭性真菌性蝶窦炎患者临床特征比较采用χ^(2)检验或Fisher精确检验;选取单因素分析中P<0.2的影响因素进行多因素回归分析。结果44例患者中,男性19例,女性25例;男女性别比为1∶1.3;出现视觉症状时平均年龄(61.48±12.17)岁。患有免疫功能异常性疾病23例(52.3%,23/44),其中糖尿病21例。主述视力下降33例44只眼(75.0%,33/44);双眼复视伴眼球运动障碍15例(34.0%,15/44),其中同时伴视力下降6例。就诊时患眼视力无光感~0.8。伴头痛35例(79.5%,35/44),伴鼻部症状14例(31.8%,14/44)。蝶窦曲霉菌、毛霉菌感染分别为40、4例。行鼻窦或眼眶CT检查的37例患者,均可见窦腔内软组织填充;其中窦腔内高密度钙化影19例(51.4%,19/37),窦壁骨质缺损24例(64.9%,24/37),窦壁骨质增生硬化26例(70.3%,26/37)。行副鼻窦、颅脑或眼眶MRI检查的34例患者中,蝶窦内病变T1WI呈弱信号、强信号、等信号分别为14、10、9例;T2WI呈强信号、弱信号、等信号分别为13、16、2例;增强后病变强化11例,无明显强化23例,病变周围黏膜增厚强化。病变累及眶尖、海绵窦分别为18、16例;同时累及眶尖及海绵窦12例。手术后6个月,视力显著提高27只眼(65.9%,27/41),视力
Objective To observe the clinical characteristics of patients with visual impairment caused by fungal sphenoid sinusitis and analyze the influencing factors related to visual prognosis.Methods A retrospective clinical study.From January 2006 to December 2020,44 patients(55 eyes)with visual impairment caused by fungal sphenoid sinusitis confirmed by imaging and pathological examination in the Department of Ophthalmology of Beijing Tongren Hospital were included in the study.Patients was first diagnosed in the Department of Ophthalmology due to monocular or binocular vision loss,or binocular diplopia,limited eye movement and ptosis.All patients underwent visual acuity examination and fundus color photography.CT examination of paranasal sinus or orbit was performed in 37 cases;magnetic resonance imaging(MRI)of paranasal sinus,brain or orbit was performed in 34 cases.All patients underwent endoscopic sinus opening combined with intrasinus lesion clearance;14 cases were treated with antifungal drugs after operation.The average follow-up time was 59.61±37.70 months.Comparison of clinical characteristics between invasive and non-invasive fungal sphenoid sinusitis were byχ^(2) test or Fisher exact test.The influencing factors with P<0.2 in univariate analysis were selected for multivariate regression analysis.Results Among the 44 patients,there were 19 males and 25 females;the ratio of male to female was 1:1.3;the average age of visual symptoms was 61.48±12.17 years;23 cases(52.3%,23/44)suffered from immune dysfunction,including 21 cases of diabetes mellitus.The visual acuity decreased in 33 cases(44 eyes)(75.0%,33/44).There were 15 cases of binocular diplopia with eye movement disorder(34.0%,15/44),including 6 cases with visual impairment.The visual acuity of the affected eye was no light perception-0.8.There were 35 cases with headache(79.5%,35/44).Nasal symptoms were found in 14 cases(31.8%,14/44).There were 40 and 4 cases of Aspergillus and Mucor infection in sphenoid sinus,respectively.Among the 37 cases who unde
作者
邵永慧
黄谦
陈玥
杨本涛
姜利斌
Shao Yonghui;Huang Qian;Chen Yue;Yang Bentao;Jiang Libin(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2021年第11期872-878,共7页
Chinese Journal of Ocular Fundus Diseases
基金
首都卫发展科研专项基金 (首发2020-2-1082)。
关键词
蝶窦炎
眼感染
真菌性
视觉障碍
Sphenoid sinusitis
Eye infections,fungal
Vision disorders
