Gupta Nishi, Singla Poonam, Pradhan Bibhu, Gurung Urmila
Dr Shroff's Charity Eye Hospital, Daryaganj, New Delhi 110002, India.
TU Teaching Hospital, Kathmandu, Nepal.
Saudi J Ophthalmol. 2019 Jul-Sep;33(3):283-290. doi: 10.1016/j.sjopt.2019.05.002. Epub 2019 May 28.
Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily and is caused by an aquatic protistan parasite. The nose is the most common site of involvement and is seen in 83.3% cases, followed by ocular involvement in 11.2% cases and other sites like larynx, trachea and bronchus in 5.5% cases. In various oculosporidiosis case series, lacrimal drainage system involvement was seen to vary from 14.3% to 59.6% cases. Isolated lacrimal sac involvement in rhinosporidiosis was found in 45.8% (72 out of 157) cases of the lacrimal drainage system in a review of 31 studies. A variety of surgical procedures have been used to treat rhinosporidiosis of lacrimal sac like dacryocystorhinostomy, Dacryocystectomy, lateral rhinotomy and local lesion excision with a success rate varying from 28.5% to 92.3%. This wide variation in the success rate was due to the fact that a uniform surgical procedure was performed in all the cases of a particular series irrespective of the extent of disease. Grading the lacrimal sac rhinosporidiosis to decide the extent of surgical excision may help achieve better results. We present a grading system based on our own experience in a case of extensive rhinospodiosis of lacrimal sac and review of 31 studies published in the literature. A 24-year-old male from Nepal presented with the complaints of watering from his right eye of 13 years duration, swelling in the right medial canthal area with an extension to the inferior part of the orbit for 12 years and nasal blockage for 1.5 years. The patient had a history of previous intervention in which biopsy was taken from the nose and sent for histopathology that confirmed rhinosporidiosis. An extended intranasal endoscopic dacryocystectomy was done along with debridement and coblation of the lesion over the septum and nasopharynx. Intraoperatively a large rhinosporidiosis mass was seen filling the sac and was removed in toto along with the sac and nasolacrimal duct. Recurrence of a tiny lesion after 6 months in our case despite wide excision with the drilling of bony nasolacrimal duct and coblation, made us review the literature.
鼻孢子虫病是一种主要累及黏膜的慢性肉芽肿性疾病，由一种水生原生动物寄生虫引起。鼻子是最常受累的部位，83.3%的病例可见，其次是眼部受累，占11.2%，其他部位如喉、气管和支气管受累占5.5%。在各种眼部鼻孢子虫病病例系列中，泪道系统受累情况在14.3%至59.6%的病例中有所不同。在对31项研究的综述中，发现鼻孢子虫病孤立性泪囊受累在泪道系统病例中占45.8%（157例中的72例）。已采用多种外科手术治疗泪囊鼻孢子虫病，如泪囊鼻腔吻合术、泪囊切除术、鼻侧切开术和局部病变切除术，成功率从28.5%到92.3%不等。成功率差异如此之大是因为在特定系列的所有病例中都采用了统一的手术方法，而不管疾病的程度如何。对泪囊鼻孢子虫病进行分级以确定手术切除范围可能有助于取得更好的效果。我们根据自己在一例广泛的泪囊鼻孢子虫病病例中的经验以及对文献中发表的31项研究的综述，提出一种分级系统。一名来自尼泊尔的24岁男性，主诉右眼流泪13年，右内眦区肿胀并延伸至眼眶下部12年，鼻塞1.5年。患者有既往干预史，曾从鼻子取活检并送去做组织病理学检查，确诊为鼻孢子虫病。进行了扩大的鼻内镜下泪囊切除术，同时对鼻中隔和鼻咽部的病变进行清创和消融。术中可见一个巨大的鼻孢子虫病肿物充满泪囊，将其与泪囊和鼻泪管一并完整切除。尽管我们的病例在广泛切除并钻除骨性鼻泪管和进行消融后6个月仍有微小病变复发，但这促使我们对文献进行了回顾。
