Li Emily, Howard Martha A, Vining Eugenia M, Becker Richard D, Silbert Jonathan, Lesser Robert L
a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA.
b Section of Otolaryngology, Department of Surgery , Yale University School of Medicine , New Haven , Connecticut , USA.
Orbit. 2018 Aug;37(4):280-286. doi: 10.1080/01676830.2017.1423087. Epub 2018 Jan 5.
Sphenoid sinus mucoceles (SSMs) are rare, benign lesions that can expand, often presenting with ocular symptoms-decreased vision, diplopia, visual field defects, proptosis, and external ophthalmoplegia. Reported cases are few, visual compromise varies, and factors affecting visual prognosis are poorly characterized. We investigate whether prompt surgical intervention (within 2 weeks of visual symptom onset) affects best-corrected visual acuity (BCVA) regained in patients with vision loss secondary to compressive SSM. We present a retrospective review of three cases and published literature to date. Our primary outcome was BCVA regained after surgical intervention; secondary outcomes included change in visual field defect and ophthalmological symptoms other than vision loss. Our three cases of SSM varied in onset, ranging from several hours to several months with patients aged from 13 to 80 years. All patients had severe vision loss to light perception (LP) or worse. Rapid neuro-imaging and urgent surgical intervention improved vision to count fingers at best. Of the two patients who underwent prompt decompression, one improved from no LP to LP and the other did not recover any vision. The patient who had visual loss for 3 months before intervention improved from LP to 20/400. Findings from our literature search, which yielded 12 cases of urgent intervention, supported the variability in visual prognosis despite prompt surgical intervention. SSMs are rare, pathologically benign lesions which can expand to cause ocular involvement. Prompt diagnosis and surgical decompression are recommended, but visual recovery may be limited even with urgent intervention.
蝶窦黏液囊肿（SSMs）是罕见的良性病变，可发生扩张，常表现为眼部症状，如视力下降、复视、视野缺损、眼球突出和眼球外肌麻痹。报道的病例较少，视力损害程度各异，影响视力预后的因素也缺乏明确特征。我们研究了及时手术干预（在视觉症状出现后2周内）是否会影响因压迫性SSM导致视力丧失患者术后最佳矫正视力（BCVA）的恢复情况。我们对3例病例及迄今为止已发表的文献进行了回顾性分析。我们的主要观察指标是手术干预后BCVA的恢复情况；次要观察指标包括视野缺损的变化以及除视力丧失外的其他眼部症状。我们的3例SSM病例发病时间各不相同，从数小时到数月不等，患者年龄在13至80岁之间。所有患者均有严重视力丧失，仅存光感（LP）或更差。快速神经影像学检查和紧急手术干预后，视力最佳恢复到能数指。在2例接受及时减压的患者中，1例从无光感改善到有光感，另1例视力未恢复。干预前视力丧失3个月的患者从光感改善到20/400。我们的文献检索发现了12例紧急干预的病例，结果表明尽管进行了及时手术干预，但视力预后仍存在差异。SSMs是罕见的、病理上为良性的病变，可扩张并导致眼部受累。建议及时诊断并进行手术减压，但即使进行紧急干预，视力恢复可能也有限。
