Neuro-ophthalmologic Outcomes of Orbital Apex Syndrome Caused by Invasive Fungal Rhinosinusitis

Minhae Park; Joongbo Shin; Eunkyu Lee; Gwanghui Ryu; Min Chae Kang; Kyung-Ah Park; Doo-Sik Kong; Kyungmin Huh; Kyunga Kim; Hyo-Yeol Kim; Yong Gi Jung; Sang Duk Hong

doi:10.1055/a-2244-4660

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2025; 86(01): 066-075
DOI: 10.1055/a-2244-4660

Original Article

Neuro-ophthalmologic Outcomes of Orbital Apex Syndrome Caused by Invasive Fungal Rhinosinusitis

Autoren

Minhae Park

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Joongbo Shin

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Eunkyu Lee

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Gwanghui Ryu

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Min Chae Kang

²Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Kyung-Ah Park

²Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Doo-Sik Kong

³Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Kyungmin Huh

⁴Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Kyunga Kim

⁵Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

⁶Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

⁷Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Hyo-Yeol Kim

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Yong Gi Jung

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Sang Duk Hong

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Abstract

Objectives Orbital apex syndrome (OAS) is characterized by visual loss, ophthalmoplegia, ptosis, and orbital pain. This study aims to analyze neuro-ophthalmologic outcomes of OAS resulting from invasive fungal rhinosinusitis (IFS).

Methods This retrospective study analyzed 25 patients diagnosed with OAS resulting from IFS between January 2018 and July 2022. Patient's visual acuity, degree of ophthalmoplegia, ptosis, and orbital pain were analyzed. Poor and nonpoor visual acuity were classified based on 20/200. The study also investigated risk factors for the failure of vision restoration.

Results Only 1 of 25 patients died from the progression of IFS. Among the 25 patients, 5 (20%) had initial visual acuity better than 20/200 before treatment and 20 (80%) had worse vision than 20/200. Four (80%) of five patients with better than 20/200 maintained visual acuity. Four (20%) of 20 patients with worse than 20/200 recovered to better than 20/200 but others remained or declined to worse vision after treatment. The presence of an infiltrative lesion in cavernous sinus on magnetic resonance image scans was significant in univariate but not multivariate analysis (odds ratio, 24.39; 95% confidence interval, 1.543–333.333; P-value = 0.023). Among the patients with worse than 20/200 vision, the patients whose treatment started less than 4 weeks achieved 33.3% (4/12 patients) vision recovery. In contrast, ophthalmoplegia, ptosis, and pain recovered more successfully than vision.

Conclusion Although OAS caused by IFS has been reported as very rare, early pathological diagnosis and appropriate treatment can result in good survival and favorable neuro-ophthalmologic outcomes.

Keywords

invasive fungal sinusitis - computed tomography - endoscopic sinus surgery - fungal sinusitis - imaging

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Referenzen

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