Chen Jia-Qi, Sun Ming-xia, Sha Xiang-yin, Zhang Ping, Lin Yue-sheng, Li Hui, Liu Yong-min, Chen Long-shan
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Yan Ke Za Zhi. 2006 Jan;42(1):22-6.
To study the management of "no touch technique" surgical excision and corneoscleral lamellar keratoplasty in the treatment of corneo-conjunctival malignant melanoma.
Surgical excision for corneo-conjunctival malignant melanoma in six cases, from October 1989 to January 2004 in Zhongshan Ophthalmic Center, were performed. The entire tumors were removed in one piece without touching the tumor (no touch technique). The incision was outlined 4-6 mm outside the pigmented conjunctival mass, and 2 mm outside the corneal component. Dissecting deep enough without any tumor cell left to yield a tumor-free bed. After surgical incision, the host eyeball defect was covered with partial or total corneoscleral lamellar graft from fresh donor, and the conjunctiva defect was covered with or without amniotic membrane transplantation. All the patients were followed up to 6 months.
The tumors in the remaining conjunctival margins were completely removed by local dissection combined with cryotherapy in the six cases. Three cases were treated with partial corneoscleral lamellar keratoplasty, two cases with total corneoscleral lamellar keratoplasty and one case with total corneoscleral lamellar keratoplasty plus amniotic membrane transplantation. All cases were subsequently treated with 0.01% thiotepa eyedrops and supplemental dacarbazine chemotherapy. At the average 43.5 months follow-up time (14.6 years to 6 months), no evidences of local recurrence of malignant melanoma or distant metastasis were observed.
The clinical study suggests that using surgical excision of "no touch technique" to remove tumor in whole piece with corneoscleral lamellar keratoplasty is effective in the treatment of corneo-conjunctival malignant melanoma.
探讨“无瘤技术”手术切除联合角巩膜板层角膜移植术治疗角结膜恶性黑色素瘤的方法。
对1989年10月至2004年1月在中山眼科中心就诊的6例角结膜恶性黑色素瘤患者行手术切除。采用“无瘤技术”完整切除肿瘤，不接触肿瘤组织。在色素沉着的结膜肿物外4 - 6 mm、角膜肿物外2 mm处标记切口。充分分离至无肿瘤细胞残留，形成无瘤床。手术切口后，用新鲜供体的部分或全层角巩膜板层移植片覆盖宿主眼球缺损区，结膜缺损区根据情况行或不行羊膜移植。所有患者随访6个月。
6例患者残留结膜边缘肿瘤经局部切除联合冷冻治疗后完全切除。3例行部分角巩膜板层角膜移植术，2例行全层角巩膜板层角膜移植术，1例行全层角巩膜板层角膜移植术联合羊膜移植术。所有病例术后均用0.01%塞替派滴眼液及补充达卡巴嗪化疗。平均随访43.5个月（6个月至14.6年），未见恶性黑色素瘤局部复发及远处转移迹象。
临床研究表明，采用“无瘤技术”手术完整切除肿瘤联合角巩膜板层角膜移植术治疗角结膜恶性黑色素瘤是有效的。
