Park In Ki, Lee Seok Hyun, Chun Yeoun Sook
Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2011 Aug;25(4):294-7. doi: 10.3341/kjo.2011.25.4.294. Epub 2011 Jul 22.
A 69-year old man presented to us with decreased vision in his right eye and a relative afferent pupillary defect. Under the presumption that he was suffering from retrobulbar optic neuritis or ischemic optic neuropathy, visual field tests were performed, revealing the presence of a junctional scotoma. Imaging studies revealed tumorous lesions extending from the sphenoid sinus at the right superior orbital fissure, with erosion of the right medial orbital wall and optic canal. Right optic nerve decompression was performed via an endoscopic sphenoidectomy, and histopathologic examination confirmed the presence of aspergillosis. The patient did not receive any postoperative antifungal treatment; however, his vision improved to 20 / 40, and his visual field developed a left congruous superior quadrantanopsia 18 months postoperatively. A junctional scotoma can be caused by aspergillosis, demonstrating the importance of examining the asymptomatic eye when a patient is experiencing a loss of vision in one eye. Furthermore, damage to the distal optic nerve adjacent to the proximal optic chiasm can induce unusual congruous superior quadrantanopsia.
一名69岁男性因右眼视力下降和相对性传入性瞳孔障碍前来就诊。基于他患有球后视神经炎或缺血性视神经病变的推测，进行了视野检查，结果显示存在交界性暗点。影像学研究显示肿瘤性病变从右侧眶上裂的蝶窦延伸，右侧眶内侧壁和视神经管受侵蚀。通过内镜蝶窦切除术进行了右侧视神经减压，组织病理学检查证实为曲霉菌病。患者术后未接受任何抗真菌治疗；然而，他的视力改善到了20/40，术后18个月其视野出现了左侧一致性上象限盲。交界性暗点可由曲霉菌病引起，这表明当患者一只眼睛出现视力丧失时，检查无症状的眼睛具有重要意义。此外，靠近视交叉近端的远端视神经损伤可诱发不寻常的一致性上象限盲。
