Char D H, Miller T, Crawford J B
Tumori Eye Foundation, San Francisco, California, USA.
Trans Am Ophthalmol Soc. 2000;98:153-9; discussion 159-61.
To review the ocular retention rates, visual results, and metastases in uveal tumors managed with eye-wall resection techniques.
This was a retrospective analysis of uveal tumors selected for eye-wall resection with the surgical procedures performed by a single surgeon. All enucleation specimens were reviewed by one author. Both parametric and non-parametric analysis of data was performed.
A total of 132 eyes were scheduled for eye-wall resection surgery. Mean patient age was 52 years (range, 11 to 86 years). Tumors involved the iris alone in 17 cases, the iris-ciliary body in 53, the ciliary body alone in 16, and the choroid (ciliochoroidal, iris-ciliary body-choroid, or choroid) in 46 cases. A total of 114 eyes harbored melanomas; tumors located more posteriorly were more likely to have epithelioid cells (P < .05). Mean follow-up was 6 years. Mean number of clock hours in iris and iris-ciliary body tumors was 3.5. In tumors that involved the choroid, the mean largest diameter was 12.6 mm and the mean thickness was 8.2 mm. Ninety-three (70%) of 132 eyes were retained. Histologic assessment of surgical margins did not correlate with either evidence of tumor in enucleated eyes or metastatic disease. Surgical margins of tumors located more anteriorly were more likely to be clear on histologic evaluation (P < .05). Approximately 56% of retained eyes had a final visual acuity of 20/40 or better; visual results were significantly better in tumors located more anteriorly (P < .05). All retained eyes with iris tumors had a final visual acuity of 20/40 or better. In tumors that involved the choroid, 8 of 25 retained eyes kept visual acuity of 20/40 or better. Metastases developed in 8 patients; all metastatic events developed in patients with tumors that involved the choroid, and 7 of 8 were mixed cell melanomas.
Seventy percent of eyes were retained, and 56% of these had a final visual acuity of 20/40 or better. Only 7% of patients with uveal melanoma developed metastatic disease (mean follow-up, 6 years). Survival did not appear to be compromised with eye-wall resection, and in very thick melanomas located more posteriorly, ocular retention and visual results appeared to be better than that attained with radiation alone.
回顾采用眼壁切除术治疗葡萄膜肿瘤的眼球保留率、视觉效果及转移情况。
这是一项对因眼壁切除术而入选的葡萄膜肿瘤进行的回顾性分析，手术由同一位外科医生完成。所有眼球摘除标本均由一位作者进行检查。对数据进行了参数分析和非参数分析。
共有132只眼计划接受眼壁切除手术。患者平均年龄为52岁（范围11至86岁）。肿瘤仅累及虹膜17例，虹膜 - 睫状体53例，仅累及睫状体16例，累及脉络膜（睫状脉络膜、虹膜 - 睫状体 - 脉络膜或脉络膜）46例。共有114只眼患有黑色素瘤；位置越靠后的肿瘤越可能有上皮样细胞（P < 0.05）。平均随访时间为6年。虹膜及虹膜 - 睫状体肿瘤的平均钟点数为3.5。累及脉络膜的肿瘤，平均最大直径为12.6 mm，平均厚度为8.2 mm。132只眼中有93只（70%）眼球得以保留。手术切缘的组织学评估与眼球摘除眼中的肿瘤证据或转移性疾病均无相关性。位置更靠前的肿瘤手术切缘在组织学评估中更可能为阴性（P < 0.05）。约56%的保留眼球最终视力达到20/40或更好；位置更靠前的肿瘤视觉效果明显更好（P < 0.05）。所有保留的虹膜肿瘤眼球最终视力均达到20/40或更好。在累及脉络膜的肿瘤中，25只保留眼球中有8只视力保持在20/40或更好。8例患者发生转移；所有转移事件均发生在累及脉络膜的肿瘤患者中，8例中有7例为混合细胞黑色素瘤。
70%的眼球得以保留，其中56%最终视力达到20/40或更好。葡萄膜黑色素瘤患者中仅7%发生转移性疾病（平均随访6年）。眼壁切除术似乎未影响生存率，对于位置更靠后、厚度很大的黑色素瘤，眼球保留率和视觉效果似乎优于单纯放疗。
