García-Arumí J, Zapata M A, Balaguer O, Fonollosa A, Boixadera A, Martinez-Castillo V
Hospital Vall d'Hebron, Barcelona, Spain.
Br J Ophthalmol. 2008 Aug;92(8):1040-5. doi: 10.1136/bjo.2008.137562.
Eyes with high posterior choroidal melanomas are frequently enucleated because of the potential complications of radiotherapy. The aim of this study was to evaluate the safety and efficacy of endoresection at long-term follow-up.
Retrospective, non-randomised, interventional case series. Thirty-eight patients underwent endoresection. For primary procedures, inclusion criteria were tumour thickness >or=8 mm, base <15 mm, tumours not exceeding the equatorial area. Endoresection was also undertaken as the salvage procedure in four patients. Main outcomes measured were metastatic disease, survival, local recurrences, visual acuity, enucleation rate, and surgical complications.
Follow-up time ranged from 23 to 129 months (mean 70.63 months). Preoperative visual acuity ranged from "hand-movements" to 20/20 (mean, 20/60). In primary cases, mean tumour thickness was 10.1 mm and mean base diameter 9.9 mm. At the latest visit, 92.1% patients still retained the eye. Final visual acuity ranged from "no light perception" to 20/30 (mean 20/300). Two patients experienced local recurrence before 3 years of follow-up. Melanoma metastatic disease was found in two patients at 5 years of follow-up. Kaplan-Meier survival analysis for all causes was 88.2% at 5 years. Specific survival was 90.9% at 5 years.
At long-term follow-up, the risk of metastasis or local recurrence, and survival rates were similar to other techniques, although comparisons are difficult because of the unusual presentation of this type of melanoma. Further studies and longer follow-up are needed.
由于放射治疗存在潜在并发症，后部脉络膜黑色素瘤厚度较大的眼睛常被摘除。本研究的目的是评估长期随访时眼球内切除术的安全性和有效性。
回顾性、非随机、介入性病例系列研究。38例患者接受了眼球内切除术。对于初次手术，纳入标准为肿瘤厚度≥8mm、基底<15mm、肿瘤未超过赤道区域。4例患者也接受了眼球内切除术作为挽救性手术。主要测量的结果包括转移性疾病、生存率、局部复发、视力、摘除率和手术并发症。
随访时间为23至129个月（平均70.63个月）。术前视力范围从“手动”到20/20（平均20/60）。在初次手术病例中，平均肿瘤厚度为10.1mm，平均基底直径为9.9mm。在最近一次随访时，92.1%的患者仍保留眼球。最终视力范围从“无光感”到20/30（平均20/300）。2例患者在随访3年之前出现局部复发。2例患者在随访5年时发现黑色素瘤转移性疾病。所有原因的Kaplan-Meier生存分析显示5年生存率为88.2%。特定生存率在5年时为90.9%。
在长期随访中，转移或局部复发的风险以及生存率与其他技术相似，尽管由于这类黑色素瘤的特殊表现难以进行比较。需要进一步的研究和更长时间的随访。
