Soucková I, Soucek P
Oftalmologická klinika FNKV, Praha.
Cesk Slov Oftalmol. 2008 Nov;64(6):228-30.
To investigate the input of optical coherence tomography (OCT) in evaluation of tissue changes in small choroidal melanocytic lesions.
We reviewed charts of 20 patients with uveal melanocytic tumors (9 with benign lesions and 11 with malignant ones). The best-corrected visual acuity (BCVA) was of 1.0-0.1 in the benign lesions and of 1.0-0.07 in the malignant ones at the time of presentation. Both fundi were examined after pupil dilatation using an indirect ophthalmoscope and a Goldmann lens.The tumor and the macula were captured and the ultrasound (US) was performed in all patients. Height of the tumor was of 1.3-1.7 mm in the benign lesions and of 1.40-2.8 mm in the malignant ones at presentation. The OCT scans have been placed to document the apex, the slope and the base of the tumor and the macula. The retinal thickness at the fixation point (RTFP) and the macular volume were of 140-357 microm and 6.1-7.6 mm3 respectively in benign lesions, and of 173-680 microm and 5.9-14.4 mm3 respectively in malignant ones at the presentation. Fluorescein angiography was indicated in 9 patients and indocyanine green in 8 of them.The follow-up period varied between 6 and 24 months in benign lesions and from 6 to 48 months in malignant ones. The following methods were used when indicated: laser photocoagulation, photodynamic therapy with verteporfin, brachytherapy, Leksell Gamma Knife irradiation, enucleation or combination of them.
The BCVA remained the same in the benign lesions but worsened to 0.8-0 in the malignant ones; the height of the tumor on US did not change in benign lesions and measured of 1.4-2.8 mm in malignant ones; RTFP and macular volume on OCT were of 156-412 microm and 7.1-8.2 mm3 respectively in benign lesions and of 124-506 microm and 3.8-8.8 mm3 respectively in malignant ones at the last visit. Qualitative analysis included the presence of subretinal and intraretinal fluid, convex deformity of the scan, increased reflectivity of the retinal pigment epithelium (RPE) or the choroid and disruption of the RPE.
It seems that OCT is one of the most important examination methods to distinguish small choroidal melanocytic lesions to be benign or malignant. OCT findings play important role to detect the active lesion that requires treatment before it starts to grow. It is needed to enlarge our study group and to increase its follow-up period.
探讨光学相干断层扫描（OCT）在评估脉络膜小黑色素细胞病变组织变化中的作用。
我们回顾了20例葡萄膜黑色素细胞瘤患者的病历（9例为良性病变，11例为恶性病变）。初诊时，良性病变患者的最佳矫正视力（BCVA）为1.0 - 0.1，恶性病变患者的最佳矫正视力为1.0 - 0.07。所有患者均在散瞳后使用间接检眼镜和戈德曼三面镜检查眼底。对肿瘤和黄斑进行拍照，并对所有患者进行超声（US）检查。初诊时，良性病变肿瘤高度为1.3 - 1.7mm，恶性病变肿瘤高度为1.40 - 2.8mm。进行OCT扫描以记录肿瘤及黄斑的顶点、斜率和底部。初诊时，良性病变在注视点处的视网膜厚度（RTFP）和黄斑体积分别为140 - 357微米和6.1 - 7.6立方毫米，恶性病变分别为173 - 680微米和5.9 - 14.4立方毫米。9例患者进行了荧光素血管造影，其中8例进行了吲哚菁绿血管造影。良性病变的随访期为6至24个月，恶性病变为6至48个月。根据需要采用以下方法：激光光凝、维替泊芬光动力疗法、近距离放射治疗、Leksell伽玛刀照射、眼球摘除术或联合应用这些方法。
良性病变的BCVA保持不变，而恶性病变的BCVA恶化至0.8 - 0；良性病变超声检查显示肿瘤高度无变化，恶性病变肿瘤高度为1.4 - 2.8mm；末次随访时，良性病变OCT检查的RTFP和黄斑体积分别为156 - 412微米和7.1 - 8.2立方毫米，恶性病变分别为124 - 506微米和3.8 - 8.8立方毫米。定性分析包括视网膜下和视网膜内液的存在、扫描的凸面变形、视网膜色素上皮（RPE）或脉络膜反射率增加以及RPE的破坏。
OCT似乎是鉴别脉络膜小黑色素细胞病变是良性还是恶性的最重要检查方法之一。OCT检查结果在检测需要在开始生长前进行治疗的活动性病变方面发挥着重要作用。需要扩大我们的研究组并延长随访期。
