乳头旁毛细血管瘤。临床特征及视力预后

Juxtapapillary capillary hemangiomas. Clinical features and visual acuity outcomes.

作者信息

McCabe C M, Flynn H W, Shields C L, Shields J A, Regillo C D, McDonald H R, Berrocal M H, Gass J D, Mieler W F

机构信息

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.

出版信息

Ophthalmology. 2000 Dec;107(12):2240-8. doi: 10.1016/s0161-6420(00)00422-x.

DOI:10.1016/s0161-6420(00)00422-x

PMID:11097604

Abstract

OBJECTIVE

To describe the clinical features, association with von Hippel-Lindau (VHL) disease and visual acuity outcomes of patients with a juxtapapillary capillary hemangioma.

DESIGN

Retrospective observational case series.

PARTICIPANTS

Seventy-two eyes of 68 patients identified with a juxtapapillary capillary hemangioma. Follow-up data of at least 6 months duration were available for 60 eyes.

METHODS

A retrospective chart review of patients diagnosed with a juxtapapillary capillary hemangioma examined at four medical centers.

MAIN OUTCOME MEASURES

Age at diagnosis, visual acuity (VA) at first examination and at last follow-up, tumor growth pattern and location, associated clinical features, type of treatment, association with VHL, and presence of peripheral hemangiomas were recorded for each patient.

RESULTS

On initial examination, VA was >/=20/40 in 43 of 70 eyes (61%) and was >/=20/200 in 60 eyes (86%). At an average follow-up of 5.4 years (range, 0.5-19 years), VA of >/=20/40 was achieved in 21 eyes (35%) and >/=20/200 in 33 eyes (55%). Patients with VHL had poorer initial VA (48% vs. 70% with VA >/=20/40, and 74% vs. 93% with VA >/=20/200) and final VA (26% vs. 41% with VA >/=20/40, and 39% vs. 65% with VA >/=20/200) compared with patients without VHL. Patients with VHL more commonly were seen at an earlier age (average, 20 vs. 44 years, P: < 0.001), with bilateral (17% vs. 0%), and/or peripheral (39% vs. 0%) (P: < 0.001) tumors that more often had an endophytic growth pattern (63% vs. 22%, P: = 0.001) compared with patients without VHL. Patients selected for laser treatment generally had poorer initial (52% vs. 74% with VA >/=20/40, 79% vs. 96% with VA >/=20/200) and final VAs (18% vs. 56% with VA >/=20/40, 45% vs. 67% with VA >/=20/200) compared with patients not treated with laser.

CONCLUSIONS

On long-term follow-up of patients with a juxtapapillary capillary hemangioma, the VA generally worsens. Patients with VHL and a juxtapapillary hemangioma more often present at a younger age, have tumors with an endophytic growth pattern, and have bilateral, multiple tumors. Treatment with laser photocoagulation results in variable VA outcomes.

摘要

目的

描述视乳头旁毛细血管瘤患者的临床特征、与冯·希佩尔-林道（VHL）病的关联以及视力预后。

设计

回顾性观察病例系列。

参与者

68例被确诊为视乳头旁毛细血管瘤患者的72只眼。60只眼有至少6个月的随访数据。

方法

对在四个医疗中心接受检查的被诊断为视乳头旁毛细血管瘤的患者进行回顾性病历审查。

主要观察指标

记录每位患者的诊断年龄、首次检查和末次随访时的视力（VA）、肿瘤生长模式和位置、相关临床特征、治疗类型、与VHL的关联以及周边血管瘤的存在情况。

结果

初次检查时，70只眼中有43只（61%）的VA≥20/40，60只眼（86%）的VA≥20/200。平均随访5.4年（范围0.5 - 19年）时，21只眼（35%）的VA≥20/40，33只眼（55%）的VA≥20/200。与无VHL的患者相比，VHL患者的初始VA（VA≥20/40者为48%对70%，VA≥20/200者为74%对93%）和最终VA（VA≥20/40者为26%对41%，VA≥20/200者为39%对65%）较差。VHL患者更常见于较年轻的年龄（平均20岁对44岁，P：<0.001），有双侧（17%对0%）和/或周边（39%对0%）（P：<0.001）肿瘤，且与无VHL的患者相比，肿瘤更常呈内生性生长模式（63%对22%，P：=0.001）。与未接受激光治疗的患者相比，选择激光治疗的患者初始（VA≥20/40者为52%对74%，VA≥20/200者为79%对96%）和最终VA（VA≥20/40者为18%对56%，VA≥20/200者为45%对67%）通常较差。