Otaif Abdulrahman A, Najmi Ammar A, Shajry Ibrahim M, Jahlan Riyadh A, Daghreeri Abdulrahman A, Otaif Abdulelah A, Alali Hatoun A, Alanazi Ghadah Khalid H, Al Mustafa Wejdan A, Alharbi Deema F, Alotaibi Lujain B, Althagafi Amal S, Aladwan Shahad S
Faculty of Medicine, Jazan University, Jazan, SAU.
Department of Otorhinolaryngology - Head and Neck Surgery, Prince Mohammed bin Nasser Hospital, Jazan, SAU.
Cureus. 2024 Sep 21;16(9):e69886. doi: 10.7759/cureus.69886. eCollection 2024 Sep.
Allergic fungal rhinosinusitis (AFRS) is a severe type of chronic rhinosinusitis (CRS) characterized by a high risk of acute vision loss resulting from the affection of optic nerves. This vision loss results from direct pressure upon the optic nerve by the sinus tissues and bone degradation. This is why early involvement of a professional is significant so as not to result in a permanent disability. This systematic review and meta-analysis will analyze the efficacy of surgical operations in enhancing visual outcomes in patients with acute vision loss due to AFRS. A systematic search was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, Cochrane Library, and Scopus with the keywords "acute vision loss," "allergic fungal rhinosinusitis," and "surgical intervention." The studies included patients who developed AFRS-related acute vision loss, those assessing the outcomes of the surgical interventions, and those published in English. Two separate researchers extracted data and conducted quality assessments. The data synthesis process employed the R studio software (Posit, Boston, MA). The identified studies for the review constituted 12 and involved 320 patients. The mean pooled event rate regarding acute vision loss of AFRS patients was 33.1%. Ear, nose, and throat surgeries, including functional endoscopic sinus surgery (FESS) and optic nerve decompression, had a mean pooled success in vision recovery of 68%. Early treatment and utilization of other types of corticosteroids were utilized to enhance the results. Hence, early and proper surgery like FESS, optic nerve decompression, and corticosteroid treatment have better visual prognosis in AFRS patients. Standard early diagnosis and management guarantee the prevention of irreversible blindness, which stresses the need for an interdisciplinary approach and further studies.
变应性真菌性鼻-鼻窦炎（AFRS）是一种严重的慢性鼻-鼻窦炎（CRS），其特征是视神经受累导致急性视力丧失的风险很高。这种视力丧失是由于鼻窦组织和骨质破坏对视神经的直接压迫所致。这就是为什么专业人员尽早介入很重要，以免导致永久性残疾。本系统评价和荟萃分析将分析手术操作对改善因AFRS导致急性视力丧失患者视觉预后的疗效。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用PubMed、Embase、Cochrane图书馆和Scopus进行系统检索，关键词为“急性视力丧失”、“变应性真菌性鼻-鼻窦炎”和“手术干预”。纳入的研究包括发生与AFRS相关急性视力丧失的患者、评估手术干预结果的研究以及以英文发表的研究。两名独立的研究人员提取数据并进行质量评估。数据合成过程使用R studio软件（位于马萨诸塞州波士顿的Posit公司）。纳入本次评价的已识别研究有12项，涉及320例患者。AFRS患者急性视力丧失的平均合并事件发生率为33.1%。耳鼻喉科手术，包括功能性鼻内镜鼻窦手术（FESS）和视神经减压术，视力恢复的平均合并成功率为68%。采用早期治疗和使用其他类型的皮质类固醇来提高疗效。因此，像FESS、视神经减压术这样的早期且恰当的手术以及皮质类固醇治疗对AFRS患者有更好的视觉预后。标准的早期诊断和管理可确保预防不可逆性失明，这强调了跨学科方法和进一步研究的必要性。
