{
  "abstract": "Objective\n\nTo characterize a highly occult subtype of sphenoid invasive fungal rhinosinusitis (IFRS) presenting as acute orbital apex syndrome (OAS) without classic invasive imaging signs, and to evaluate the efficacy of early surgical intervention.Methods\n\nThis retrospective case series evaluated six patients (March 2021-November 2025) who developed classic OAS secondary to sphenoid IFRS despite strictly subtle imaging manifestations. All underwent navigation-guided endoscopic sinus clearance and optic nerve decompression. Pre- and postoperative neuro-ophthalmic parameters (best-corrected visual acuity [BCVA], visual field index [VFI], mean deviation [MD], and ocular motility) were analyzed. Bias-corrected effect sizes (Hedges' g) were calculated to quantify the magnitude of functional recovery.Results\n\nPathological evaluation confirmed Aspergillus fumigatus (n=4), Penicillium citrinum (n=1), and Rhizopus oryzae (n=1). Four patients (66.7%) had comorbid type 2 diabetes. Following surgery, median BCVA improved from 1.91 to 0.30 LogMAR (Hedges' g = 0.80). In the four patients completing visual field testing, median VFI improved from 11% to 91.5% (g = 1.37), and median MD improved from -28.02 to -3.33 dB (g = 1.23). Ocular motility fully recovered in two of three affected patients. Notably, the two patients lacking visual recovery presented with severe preoperative hyperglycemia (>14 mmol/L). No severe surgery-related complications occurred.Conclusions\n\nFor occult IFRS presenting with this striking 'clinical-radiological dissociation', early navigation-guided endoscopic exploration is a crucial sight-saving strategy. Strict glycemic control is paramount to preserving this therapeutic window. Further prospective validation is warranted.",
  "abstract_shown": true,
  "affiliations": [
    "State Key Laboratory of Eye Health, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China.",
    "State Key Laboratory of Eye Health, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China. wuwencan@wmu.edu.cn.",
    "Zhejiang Key Laboratory of Key Technologies for Visual Pathway Reconstruction, Wenzhou, 325027, China. wuwencan@wmu.edu.cn.",
    "National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China. wuwencan@wmu.edu.cn.",
    "State Key Laboratory of Eye Health, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China. 23200469@qq.com.",
    "Zhejiang Key Laboratory of Key Technologies for Visual Pathway Reconstruction, Wenzhou, 325027, China. 23200469@qq.com.",
    "National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China. 23200469@qq.com.",
    "State Key Laboratory of Eye Health, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China. sjl@wmu.edu.cn.",
    "Zhejiang Key Laboratory of Key Technologies for Visual Pathway Reconstruction, Wenzhou, 325027, China. sjl@wmu.edu.cn.",
    "National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China. sjl@wmu.edu.cn."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zhixing Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Weibin Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Yanchen Zhang"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Wencan Wu"
    },
    {
      "affs": [
        4,
        5,
        6
      ],
      "name": "Yunhai Tu"
    },
    {
      "affs": [
        7,
        8,
        9
      ],
      "name": "Jieliang Shi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7d1dma7hd8hq4.bib",
  "cited_by": 0,
  "doi": "10.1186/s12886-026-05170-4",
  "fulltext_url": "https://europepmc.org/articles/PMC13726321",
  "id": "7d1dma7hd8hq4",
  "issns": [
    "1471-2415"
  ],
  "landing_url": "https://europepmc.org/article/MED/42968036",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2731|Ocular Infections and Treatments"
    ]
  ],
  "openalex": "W7172482819",
  "pdf_url": "https://europepmc.org/articles/PMC13726321?pdf=render",
  "pmcid": "PMC13726321",
  "pmid": "42968036",
  "published": "2026-08-05",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/7d1dma7hd8hq4.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:53Z",
      "native_id": "MED:42968036",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42968036"
    },
    {
      "first_seen": "2026-11-05T12:22:41Z",
      "native_id": "PMC13726321",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12886-026-05170-4"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2731|Ocular Infections and Treatments",
      "subfield": "general"
    }
  ],
  "title": "Orbital apex syndrome caused by imaging-occult sphenoid sinus fungal infection and the necessity of early surgical exploration: a retrospective case series.",
  "title_text": "Orbital apex syndrome caused by imaging-occult sphenoid sinus fungal infection and the necessity of early surgical exploration: a retrospective case series.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:19Z",
  "url": "https://research.draconitic.com/paper/7d1dma7hd8hq4",
  "venue": "BMC ophthalmology",
  "versions": []
}