睫状体肿瘤的局部切除术：中国一项长期前瞻性队列研究

Wei Wen-bin, Yang Wen-li, Hu Shi-min, Li Bin

Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.

Chin Med J (Engl). 2008 Nov 5;121(21):2152-6.

BACKGROUND

Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up.

METHODS

Twenty-two patients (22 eyes), who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. Localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages.

RESULTS

After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities (BCVA) varied from 0.02 - 1.00, including 18 patients (81.82%) who had BCVA equal to or better than that before surgery. Fifteen patients (68.18%) had BCVA better than 0.3. Only two patients had intraocular pressure (IOP) of less than 10 mmHg and the other patients maintained normal IOP. Nine cases (40.91%) were given confirmed diagnosis of malignant melanoma, four (18.18%) of melanocytoma, six (27.27%) of nonpigmented ciliary epithelial adenoma, two (9.09%) of neurofibroma, and one (4.55%) of neurinoma. Twenty patients (90.91%) had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years after the operation.

CONCLUSION

For some ciliary body tumors, especially in the early stages, local excision is an effective and safe method to save the vision and the eyeball.

背景

睫状体肿瘤在早期通常难以诊断和治疗。然而，此类肿瘤的治疗已倾向于眼保留而非眼球摘除。随着现代玻璃体切除术的发展，睫状体肿瘤的局部切除已变得有效，但长期结果仍不明确。因此，我们报告了局部切除睫状体肿瘤后的长期随访结果。

方法

本前瞻性队列研究纳入了1996年1月至2001年6月在北京同仁医院被诊断为睫状体肿瘤的22例患者（22只眼）。进行了局限性板层巩膜 - 睫状体切除术。在某些情况下，还进行了玻璃体切除术、巩膜移植术以及脉络膜前部的进一步切除术。诊断通过组织病理学检查得以证实。患者在术后随访5至11年。用描述性百分比记录他们的视力、眼压和局部复发情况。

结果

术后，所有患者的眼球外观均保持正常。6例患者保持圆形瞳孔。最终最佳矫正视力（BCVA）在0.02 - 1.00之间，其中18例患者（81.82%）的BCVA等于或优于术前。15例患者（68.18%）的BCVA优于0.3。只有2例患者的眼压（IOP）低于10 mmHg，其他患者的眼压保持正常。9例（40.91%）被确诊为恶性黑色素瘤，4例（18.18%）为黑素细胞瘤，6例（27.27%）为无色素睫状体上皮腺瘤，2例（9.09%）为神经纤维瘤，1例（4.55%）为神经鞘瘤。20例患者（90.91%）在随访期间未复发。1例黑素细胞瘤在术后7年复发，随后进行了眼球摘除术。1例患者手术切除了直径为16 mm的恶性黑色素瘤，术后5年死于肝转移。