Riley Thomas, Harshman Doug
Spokane Veteran's Affairs Medical Center, Spokane, Washington 99205, USA.
Optometry. 2004 Feb;75(2):103-14. doi: 10.1016/s1529-1839(04)70022-6.
Choroidal melanoma is the most common primary ocular tumor in adults. These tumors are almost always unilateral and develop spontaneously or arise from pre-existing nevi. Historically, treatment for choroidal melanoma was enucleation. New therapies have been developed to treat choroidal melanoma and to preserve the eye. Currently, these treatment options include brachytherapy and transpupillary thermotherapy.
A 51-year-old man came to the eye clinic with symptoms of mildly decreased fluctuating vision and floaters with no flashes in the temporal visual field of the right eye. Best-corrected visual acuities were 20/30 O.D. and 20/20 O.S. A small-to-medium choroidal lesion was found in the right eye. Ultrasonography and A-scan showed this lesion to be a choroidal malignant melanoma. The patient's surgical options included enucleation, brachytherapy, and transpupillary thermotherapy. The patient opted to have transpupillary thermotherapy to preserve the eye, and subsequently underwent two procedures that eventually obliterated the melanoma, resulting in best-corrected visual acuity of 20/40.
Transpupillary thermotherapy is an excellent option for treatment of small-to-medium choroidal melanomas. Brachytherapy is also an option for treatment, but with increased ocular side effects and complications. Enucleation is still commonly performed on medium and/or large choroidal melanomas.
脉络膜黑色素瘤是成人最常见的原发性眼部肿瘤。这些肿瘤几乎总是单侧的，可自发发生或由先前存在的痣发展而来。历史上，脉络膜黑色素瘤的治疗方法是眼球摘除术。现已开发出治疗脉络膜黑色素瘤并保留眼球的新疗法。目前，这些治疗选择包括近距离放射疗法和经瞳孔温热疗法。
一名51岁男性因右眼颞侧视野轻度波动性视力下降和飞蚊症且无闪光感的症状前来眼科诊所就诊。最佳矫正视力右眼为20/30，左眼为20/20。右眼发现一个中小脉络膜病变。超声检查和A超显示该病变为脉络膜恶性黑色素瘤。患者的手术选择包括眼球摘除术、近距离放射疗法和经瞳孔温热疗法。患者选择经瞳孔温热疗法以保留眼球，随后接受了两次手术，最终消除了黑色素瘤，最佳矫正视力达到20/40。
经瞳孔温热疗法是治疗中小脉络膜黑色素瘤的极佳选择。近距离放射疗法也是一种治疗选择，但眼部副作用和并发症会增加。对于中大型脉络膜黑色素瘤，眼球摘除术仍普遍施行。
