Ismi Onur, Vayisoğlu Yusuf, Bal Kemal Koray, Helvaci Ilter, Görür Kemal, Ozcan Cengiz
Department of Otorhinolaryngology, Faculty of Medicine.
Department of Business Information Management, Silifke School of Applied Technology and Management, University of Mersin, Mersin, Turkey.
J Craniofac Surg. 2018 Jul;29(5):1294-1299. doi: 10.1097/SCS.0000000000004531.
If left untreated, rhinosinusitis can rarely cause a devastating complication irreversible blindness (IB). Despite new technologies in endoscopic sinus surgery and use of new broad-spectrum antibiotics, IB outcome is still a problem for surgically treated orbital complication of paranasal sinus infection (OCPSI) patients, and factors leading to IB outcome are not actually known. The aim of this study was to assess the factors leading to the IB outcome for surgically treated OCPSI patients. Results of 25 surgically treated OCPSI patients in our clinic were combined with surgically treated OCPSI patients reported through the PubMed database search from the year 2007. Patients were divided into 2 groups: IB group and recovery group. Patients having at least 1 immune status-related additional risk factor (ARF) were more common in the IB group, having an at least 1 ARF had 1.683 risk value of IB outcome (RR: 1.683, P = 0.006). IB patients had statistically significant higher mean (21.87 ± 40.35, P = 0.005) time interval (days) (TI) between onset of ophthalmological symptoms and surgical intervention compared to recovery group patients (2.92 ± 2.53). ROC curve analysis for an estimation of IB outcome according to the TI value demonstrated that a cut-off value of ≥2.5 days had the ideal sensitivity (87.5%) and specificity (71.9%) that resulted in IB outcome. (80.5% power, P = 0.008) IB and recovery group patients did not differ according to orbital complication type according to Chandler's classification (P = 0.492) and white blood cell count status (P = 0.584). In conclusion, OCPSI patients with ARFs and delayed admission after onset of orbital symptoms have a higher risk of IB outcome. These patients deserve prompt evaluation and early surgical intervention to prevent blindness. With future studies, new surgical criteria, including the ARF status and onset of ophthalmological symptoms (≥2.5 days) may be added to classical surgical criteria to prevent IB for OCPSI cases.
如果不进行治疗，鼻窦炎极少会引发一种毁灭性的并发症——不可逆性失明（IB）。尽管内镜鼻窦手术有了新技术，并且使用了新型广谱抗生素，但对于接受手术治疗的鼻窦感染眼眶并发症（OCPSI）患者而言，IB的治疗效果仍是个问题，而且导致IB结局的因素实际上并不明确。本研究的目的是评估导致接受手术治疗的OCPSI患者出现IB结局的因素。将我们诊所25例接受手术治疗的OCPSI患者的结果与通过检索2007年以来PubMed数据库报告的接受手术治疗的OCPSI患者结果相结合。患者被分为两组：IB组和康复组。在IB组中，至少有1个与免疫状态相关的额外危险因素（ARF）的患者更为常见，有至少1个ARF的患者出现IB结局的风险值为1.683（相对危险度：1.683，P = 0.006）。与康复组患者（2.92±2.53）相比，IB患者眼科症状出现至手术干预之间的平均时间间隔（天数）（TI）在统计学上显著更长（21.87±40.35，P = 0.005）。根据TI值对IB结局进行估计的ROC曲线分析表明，≥2.5天的临界值具有理想的敏感性（87.5%）和特异性（71.9%），这会导致出现IB结局。（检验效能80.5%，P = 0.008）根据钱德勒分类法，IB组和康复组患者在眼眶并发症类型方面没有差异（P = 0.492），在白细胞计数状态方面也没有差异（P = 0.584）。总之，患有ARF且眼眶症状出现后延迟入院的OCPSI患者出现IB结局的风险更高。这些患者应得到及时评估和早期手术干预以预防失明。随着未来的研究，新的手术标准，包括ARF状态和眼科症状出现时间（≥2.5天）可能会被添加到经典手术标准中，以预防OCPSI病例出现IB情况。
