Mashayekhi Arman, Shields Carol L, Lee Sung Chul, Marr Brian P, Shields Jerry A
Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Retina. 2008 Feb;28(2):274-81. doi: 10.1097/IAE.0b013e318145abe8.
To report the development of retinal break or rhegmatogenous retinal detachment (RRD) after transpupillary thermotherapy (TTT) as primary or adjunct treatment of choroidal melanoma.
In this noncomparative, interventional case series, the authors reviewed medical records of 13 patients who developed retinal break or RRD following TTT. The main outcome measures were clinical features and outcome of treatment of retinal break or RRD following TTT.
Of 1574 patients managed on the Oncology Service at Wills Eye Institute with TTT as primary or adjunct treatment of choroidal melanoma, 13 (1%) developed retinal break with or without RRD. The mean patient age at diagnosis of choroidal melanoma was 56 years. Treatment for choroidal melanoma included combined plaque radiotherapy and TTT in 10 patients and TTT alone in 3 patients. The median number of TTT sessions before development of retinal break or RRD was 2. Retinal break or RRD developed at a median of 3 months following the last TTT. All the retinal breaks were located in the TTT-treated area. Retinal breaks were atrophic in 11 eyes and horseshoe shaped in 2 cases. The extent of retinal detachment was none in 1 eye, 1 quadrant or less in 5 eyes, 2 or 3 quadrants in 4 eyes, and 4 quadrants in 3 eyes. Seven patients underwent vitrectomy, one received cryotherapy and laser photocoagulation, and five were observed without treatment. In all eight patients who received treatment for RRD, the retina was attached after a mean follow-up period of 54 months with no intraocular or local extraocular tumor dissemination.
Development of retinal break or RRD is a rare complication of TTT for treatment of choroidal melanoma. The majority of these cases develop within 6 months of TTT and most are caused by atrophic retinal holes in the TTT-treated area.
报告经瞳孔温热疗法（TTT）作为脉络膜黑色素瘤的主要或辅助治疗后视网膜裂孔或孔源性视网膜脱离（RRD）的发生情况。
在这个非对照性的介入性病例系列中，作者回顾了13例在TTT后发生视网膜裂孔或RRD患者的病历。主要观察指标为TTT后视网膜裂孔或RRD的临床特征及治疗结果。
在威尔斯眼科研究所肿瘤服务中心接受TTT作为脉络膜黑色素瘤主要或辅助治疗的1574例患者中，13例（1%）发生了伴有或不伴有RRD的视网膜裂孔。脉络膜黑色素瘤诊断时患者的平均年龄为56岁。脉络膜黑色素瘤的治疗包括10例患者采用敷贴放疗联合TTT，3例患者仅采用TTT。视网膜裂孔或RRD发生前TTT治疗的中位数疗程为2次。视网膜裂孔或RRD发生的中位数时间为最后一次TTT后3个月。所有视网膜裂孔均位于TTT治疗区域。11只眼的视网膜裂孔为萎缩性，2例为马蹄形。视网膜脱离范围：1只眼无脱离，5只眼为1个象限或更小，4只眼为2或3个象限，3只眼为4个象限。7例患者接受了玻璃体切除术，1例接受了冷冻疗法和激光光凝治疗，5例未接受治疗而进行观察。在所有8例接受RRD治疗的患者中，平均随访54个月后视网膜复位，未发生眼内或局部眼外肿瘤播散。
视网膜裂孔或RRD的发生是TTT治疗脉络膜黑色素瘤的一种罕见并发症。这些病例大多数在TTT后6个月内发生，且大多数是由TTT治疗区域的萎缩性视网膜裂孔引起的。
