真菌感染性视神经炎的临床特征  

Diagnosis and management of fungal infected optic neuritis

作　　者：谭少英 徐全刚[1] 魏世辉[1] 赵杰[1] 

机构地区：[1]解放军总医院眼科,北京100853

出　　处：《眼科》2017年第3期200-204,共5页Ophthalmology in China

基　　金：国家高科技研究发展计划(863计划)基金(2015AA020511)

摘　　要：目的总结3例确诊的真菌感染性视神经炎患者的临床特点,探讨真菌感染性视神经炎的诊治要点。设计回顾性病例。研究对象3例确诊的真菌感染性视神经炎患者。方法对3例真菌感染性视神经炎患者的症状、体征、影像学检查进行总结,分析归纳真菌感染性视神经炎的临床特点及诊断要点。主要指标临床症状、体征,影像学特点,病理结果。结果 3例真菌感染性视神经炎患者均为中老年男性,单眼或双眼先后发病。合并有系统性疾病。临床表现为急性严重的视力下降,伴头痛、眼痛、眼胀,可伴有眼睑下垂和眼球运动障碍。CT表现为软组织密度影,眼眶侧壁骨质吸收。眼眶磁共振(MRI)异常信号伴不规则强化,边界不清。组织病理见菌丝孢子和真菌团。经手术清除病灶及全身长期抗真菌治疗后症状好转,病情稳定。结论急剧的单侧视力下降伴头痛、眼球胀痛,应考虑到真菌感染的可能。影像学检查辅助诊断,病理活检为诊断金标准。应及时手术清除病灶及全身长期抗真菌治疗。Objective To understand the clinical features, diagnosis and treatment of fungal optic neuritis. Design Retrospective cases. Participants Three patients with fungal infected optic neuritis. Methods The symptoms, signs, imaging examination were evaluated in 3 patients of fungal infected optic neuritis, addition with literature review and summary of the clinical characteristics and key points of diagnosis in this disease. Main Outcome Measures Clinical symptoms, signs, imaging examinations, pathologic biopsy. Results Three patients of fungal infected optic neuritis were old aged men, monocular or binocular involved, coexisted with systemic disease. Clinical manifestations included acute severe visual loss, headache, eye pain, eyelid prolapse and eye movement disorders. CT showed soft tissue density and bone resorption in the lateral wall of the orbit. Orbital magnetic resonance （MRI） showed irregular enhancement signal with unclear boundary. Pathological biopsy helped to confirm the fungal hyphae and spores. After surgical lesions removal and long-term systemic anti-fungal treatment, symptoms could be controlled in a stable condition. Conclusion Fungus infected optic neuritis should be considered when suddenly unilateral visual loss with headache or eye pain. Imaging examination can help for diagnosis and pathological biopsy is the gold standard. Early managements were suggested with surgical removal of the lesions and long-term systemic anti-fungal therapy.

关 键 词：视神经炎 真菌性 影像学 病理活检 

分 类 号：R774.61[医药卫生—眼科]