目的:探讨因炎性孤立性蝶窦疾病(ISSD)而接受经鼻内镜手术(EES)的患者视力(VA)恶化的治疗结果和预后决定因素。
方法:纳入2010年3月至2022年4月期间13例患者,14个病灶接受EES治疗。评估包括使用最小分辨率角(LogMAR)标度的对数在VA中的改进,相关症状的缓解率,并确定预测VA恢复的因素。进行了文献综述以评估与ISSD相关的VA损伤的结果。
结果:最常见的病因是肌瘤(n=5),其次是粘液囊肿和蝶窦炎的平等代表(n=4)。从症状发作到干预的平均间隔为4.7个月,平均随访时间为14.4个月。7只眼显示术前VA为2.1LogMAR或更差,复视/上睑下垂(n=8)和头痛(n=5)是主要的共同发生症状。手术后,所有辅助症状都得到改善,整体VA回收率为87.5%(提高超过0.2logMAR单位)。粘液球表现出最好的改善,而蝶窦炎的进展最小(p=0.021)。基线VA(p=0.026)和复视/上睑下垂(p=0.029)被确定为VA恢复的阴性预后因素。
结论:我们的研究结果表明,炎症性ISSD患者在EES后VA恢复的预后良好,基于疾病实体的反应变化。然而,需要进一步研究以个性化治疗策略来提高结局.
OBJECTIVE: To investigate the treatment outcomes and determinants of prognosis in patients experiencing visual acuity (VA) deterioration due to inflammatory isolated sphenoid sinus disease (ISSD) who underwent endonasal endoscopic surgery (EES).
METHODS: Thirteen patients with 14 lesions treated with EES between March 2010 and April 2022 were included. Evaluation included improvements in VA using the logarithm of the minimum angle of resolution (LogMAR) scale, resolution rates of associated symptoms, and identification of factors predicting VA recovery. A literature review was conducted to assess the outcomes for ISSD-related VA impairments.
RESULTS: The most common etiology is mycetoma (n=5), followed by an equal representation of mucocele and sphenoiditis (n=4). The mean interval from symptom onset to intervention was 4.7 months, with an average follow-up duration of 14.4 months. Seven eyes exhibited preoperative VA of 2.1 LogMAR or worse, with diplopia/ptosis (n=8) and headache (n=5) being the predominant co-occurring symptoms. After surgery, all ancillary symptoms improved, with an overall VA recovery rate of 87.5% (improvement more than 0.2 logMAR units). Mucocele exhibited the best improvements, whereas sphenoiditis showed the least progress (p=0.021). Poor baseline VA (p=0.026) and combined diplopia/ptosis (p=0.029) were identified as negative prognostic factors for VA recovery.
CONCLUSIONS: Our findings suggest a favorable prognosis for VA recovery following EES in patients with inflammatory ISSDs, with response variations based on disease entity. However, further research is needed to personalize therapeutic strategies for enhanced outcomes.