Department of Orbit, Oculoplasty & Ocular Oncology, Aravind Eye Hospital, Madurai, India.
Department of Ocular Pathology, Aravind Eye Hospital, Madurai, India.
Eye (Lond). 2019 Jun;33(6):988-994. doi: 10.1038/s41433-019-0358-6. Epub 2019 Feb 14.
Invasive sino-orbital fungal infections in immunocompetent patients are a rare clinical entity; the diagnosis and management of which is challenging. We present a large case series of invasive sino-orbital fungal granulomas in patients without pre-existing systemic immunocomprimising condition.
Retrospective case series.
Twenty cases of invasive sino-orbital/naso-orbital fungal granulomas in immunocompetent individuals.
We retrospectively analyzed all patients with orbital fungal granuloma who were treated at a tertiary referral eye center in South India between January 2005 and December 2012. Histopathologic confirmation of tissue invasion by fungal elements and presence of granulomatous inflammation was established in all cases included in the study.
Relief of patient symptoms, resolution/no progression of disease on orbital imaging, ocular, and vision salvage were the treatment outcomes studied.
Twenty patients (11 male and 9 female) were studied. Mean age of patients was 47.4 years ranging from 24-65 years. Aspergillus was the causative fungus in 18 cases while 2 were cases of mucormycosis. Surgical debulking of the orbital disease was performed in 7 patients. Exenteration was performed in 2 patients to prevent spread to the CNS. Medical therapy consisted of oral itraconazole in all patients and intravenous amphotericin B was administered in 2 patients. Average duration of medical therapy required to achieve relief from symptoms was 6-8 months. Recurrences are common and long-term follow-up is essential.
Orbital fungal infections are challenging in terms of both diagnosis and treatment. Debulking along with prolonged antifungal therapy seems to be effective in controlling the infection.
在免疫功能正常的患者中，侵袭性鼻窦眶真菌病是一种罕见的临床实体；其诊断和治疗具有挑战性。我们报告了一组无潜在系统性免疫抑制疾病的侵袭性鼻窦眶真菌性肉芽肿患者的大型病例系列。
回顾性病例系列。
20 例免疫功能正常的侵袭性鼻窦/鼻眶真菌性肉芽肿患者。
我们回顾性分析了 2005 年 1 月至 2012 年 12 月在印度南部一家三级转诊眼科中心治疗的所有眼眶真菌肉芽肿患者。所有纳入研究的病例均通过组织中真菌成分的组织侵袭和肉芽肿性炎症的存在进行了组织病理学确认。
患者症状缓解、眼眶影像学上疾病无进展或缓解、眼部和视力保留是研究的治疗结果。
20 例患者（11 例男性和 9 例女性）纳入研究。患者的平均年龄为 47.4 岁，年龄范围为 24-65 岁。18 例为曲霉菌引起，2 例为毛霉菌病。7 例患者行眼眶病变切除术。为防止向中枢神经系统扩散，2 例患者行眼眶内容剜除术。所有患者均接受口服伊曲康唑治疗，2 例患者接受静脉注射两性霉素 B 治疗。缓解症状所需的平均药物治疗时间为 6-8 个月。复发较为常见，需要长期随访。
眼眶真菌感染在诊断和治疗方面都具有挑战性。肿块清除术结合长期抗真菌治疗似乎可以有效控制感染。
