鼻内镜手术致视神经损伤的临床研究

Optic nerve injury secondary to endoscopic nasal sinus surgery

目的探讨应用鼻内镜行鼻窦手术的眼并发症发生原因及治疗方法。方法回顾性分析3例鼻内镜术后出现不同程度视功能损害者，对其视力、视野、眼电生理、对比敏感度等检查及治疗进行分析。结果鼻内镜手术操作不当可以引起视功能损伤。3例中1例经皮质类固醇冲击等治疗后视力及视野明显改善，另2例经治疗后改善不明显。结论鼻内镜手术因局部解剖位置的原因容易引起视功能损害，对于视力正常但仍主觉视力下降的患者，应行对比敏感度检查。鼻科医生必须熟练掌握相关解剖，对可能发生的眼部并发症予以足够的重视。

Objective To investigate the reasons and the treating experiences of optic nerve injurysecondary to endoscopic sinus surgeries. Methods Three cases with optic nerve injury resulting from endo- scopic sinus surgeries were retrospectively reviewed. All of the three cases suffered from loss of vision and visual field defect in varying degrees. Results Endoscopic sinus surgery could cause the damage of visual function. In those three cases, only one patient acquired obvious improvement of visual acuity and visual field after treatment, the other two had no obvious improvement. Conclusion Because of the close anatom- ic relationship between the optic nerve and the sinus, endoscopic sinus surgery is likely to cause ophthalmic complications. It＇ s necessary to take contrast sensitivity tests for early diagnosis in patients who had normal vision but decreased in subjective vision. Surgeons must have precise knowledge of the detailed anatomy, and pay attention to the possible ophthalmic complications.