Kawakami Hideaki, Mochizuki Kiyofumi, Ishida Kyoko, Ohkusu Kiyofumi
Department of Ophthalmology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu-ken, 500-8513, Japan.
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Jpn J Ophthalmol. 2017 Mar;61(2):179-188. doi: 10.1007/s10384-016-0494-5. Epub 2017 Jan 17.
To describe the clinical manifestations and prognoses in 7 patients with invasive sino-orbital aspergillosis (ISOA).
This was a retrospective study of consecutive patients who were diagnosed as having ISOA at the Gifu University Hospital and Gifu Municipal Hospital between January 1993 and December 2015. Data were collected on demographics, initial manifestations, examination findings, treatments, clinical course, and outcomes.
The median age of the 7 patients with ISOA was 68 years; 5 of them had diabetes. The initial symptoms were reduced blurred vision (57%), unilateral headaches (43%), unilateral abnormal sensations or numbness of the periorbital area (43%), and external ophthalmoplegia (43%). The medical department that the patients first visited was the ophthalmology department in 57% of the cases. The initial CT showed bone destruction in 71% and calcification in 14% of the patients. Six of the 7 cases were misdiagnosed. The definitive diagnosis of ISOA was made by histopathologic examinations of the biopsy specimens, with an average of 2.6 biopsies. All patients received aggressive antifungal treatments after the diagnosis. However, the final visual outcome was no light perception in 86% and death related to the ISOA in 43% of the patients. Patients who were older at the onset had lower survival rates.
The prognosis for patients with ISOA is poor in terms of both vision and life. Ophthalmologists are often the first examiner. ISOA should be considered in the differential diagnosis for patients with a gradually progressive orbital mass, unilateral headaches, numbness of the periorbital area, and a decrease in visual acuity of unknown origin.
描述7例侵袭性鼻窦眶曲霉病（ISOA）患者的临床表现及预后。
这是一项回顾性研究，研究对象为1993年1月至2015年12月期间在岐阜大学医院和岐阜市立医院被诊断为ISOA的连续患者。收集了患者的人口统计学资料、初始表现、检查结果、治疗方法、临床病程及转归等数据。
7例ISOA患者的中位年龄为68岁；其中5例患有糖尿病。初始症状包括视力模糊加重（57%）、单侧头痛（43%）、单侧眶周区域异常感觉或麻木（43%）以及眼球外肌麻痹（43%）。57%的患者首诊科室为眼科。初始CT检查显示，71%的患者有骨质破坏，14%的患者有钙化。7例中有6例被误诊。通过活检标本的组织病理学检查确诊为ISOA，平均活检2.6次。所有患者在确诊后均接受了积极的抗真菌治疗。然而，最终86%的患者无光感，43%的患者因ISOA死亡。发病时年龄较大的患者生存率较低。
ISOA患者在视力和生命方面的预后均较差。眼科医生常为首位检查者。对于有逐渐进展的眶部肿块、单侧头痛、眶周区域麻木及不明原因视力下降的患者，鉴别诊断时应考虑ISOA。
