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J Neurol Surg B Skull Base
DOI: 10.1055/a-2244-4660
Original Article

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

Minhae Park
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Joongbo Shin
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Eunkyu Lee
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Gwanghui Ryu
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Min Chae Kang
2   Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Kyung-Ah Park
2   Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Doo-Sik Kong 
3   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Kyungmin Huh
4   Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Kyunga Kim
5   Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
6   Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
7   Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Hyo-Yeol Kim
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Yong Gi Jung
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Sang Duk Hong 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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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.

Conclusions 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


Publication History

Received: 07 November 2023

Accepted: 10 January 2024

Accepted Manuscript online:
12 January 2024

Article published online:
09 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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