Farooq Asim V, Patel Rakesh M, Lin Amy Y, Setabutr Pete, Sartori Juliana, Aakalu Vinay K
Department of Ophthalmology, University of Illinois at Chicago College of Medicine , Chicago, Illinois , USA.
Orbit. 2015 Jun;34(3):152-9. doi: 10.3109/01676830.2015.1014512. Epub 2015 Apr 23.
To report a series of patients with fungal orbital cellulitis who underwent exenteration surgery and describe presenting features, management and outcomes at a referral center.
Retrospective case series.
From November 2011 to March 2014, four patients underwent orbital exenteration for fungal orbital cellulitis at the University of Illinois. Three patients had mucormycosis and one had aspergillosis. All patients were treated with intravenous antifungals and underwent orbital exenteration. Two patients were successfully treated with supplemental intra-orbital catheter delivery of amphotericin B. Presenting visual acuity in the affected eye ranged from 20/25 to no light perception. Some level of ophthalmoplegia was present in three patients. Significantly elevated intraocular pressure was found in two patients. All patients with mucormycosis were found to have uncontrolled diabetes mellitus. One patient had a history of myelodysplastic syndrome, chronic hepatitis C infection, polysubstance abuse and Crohn's disease. Another patient had a history of alcoholic liver cirrhosis, Crohn's disease treated with systemic immunosuppression and renal cell carcinoma. The patient with aspergillosis had myelodysplastic syndrome and portal hypertension, and the initial presentation resembled giant cell arteritis. Two of four patients died during their hospitalization.
Fungal orbital cellulitis has a high mortality rate despite aggressive antifungal treatment and orbital exenteration performed soon after the diagnosis is confirmed. Patients often have a history of immunosuppression and the onset may be insidious. There must be a high rate of suspicion for fungal orbital cellulitis given the appropriate signs and medical history in order to avoid treatment delay.
报告一系列接受眶内容剜除术的真菌性眼眶蜂窝织炎患者，并描述在一家转诊中心的临床表现、治疗及预后。
回顾性病例系列研究。
2011年11月至2014年3月，伊利诺伊大学有4例患者因真菌性眼眶蜂窝织炎接受眶内容剜除术。3例为毛霉菌病，1例为曲霉菌病。所有患者均接受了静脉抗真菌治疗并接受了眶内容剜除术。2例患者通过眼内补充两性霉素B导管给药成功治愈。患眼的初始视力范围为20/25至无光感。3例患者存在一定程度的眼球运动障碍。2例患者眼压显著升高。所有毛霉菌病患者均患有未得到控制的糖尿病。1例患者有骨髓增生异常综合征、慢性丙型肝炎感染、多种物质滥用及克罗恩病病史。另1例患者有酒精性肝硬化、接受全身免疫抑制治疗的克罗恩病及肾细胞癌病史。曲霉菌病患者有骨髓增生异常综合征和门静脉高压，其初始表现类似巨细胞动脉炎。4例患者中有2例在住院期间死亡。
尽管确诊后立即进行了积极的抗真菌治疗和眶内容剜除术，但真菌性眼眶蜂窝织炎的死亡率仍很高。患者常有免疫抑制病史，起病可能隐匿。鉴于适当的体征和病史，必须高度怀疑真菌性眼眶蜂窝织炎，以避免治疗延误。
