Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Ophthalmologica. 2010;224(1):16-21. doi: 10.1159/000233231. Epub 2009 Aug 13.
Our purpose was to report the clinical and pathological findings from uveal melanoma patients with persistent exudative retinal detachment (RD) after Gamma Knife radiosurgery (GKR).
A retrospective review was performed.
GKR was performed on 19 uveal melanoma patients from 2004 to 2006, and 5 of them developed persistent exudative RD. The mean initial largest basal tumor diameter in these 5 patients was 14.4 +/- 1.9 mm, and the mean tumor height was 9.2 +/- 1.0 mm. Marginal doses of 40-50 Gy radiation were administered. RD developed or had become aggravated an average of 3 (1-10) months after GKR. Two patients underwent enucleation, while the remaining 3 underwent tumor removal by endoresection with retinal reattachment surgery by vitrectomy and silicone oil tamponade. These procedures were undertaken an average of 6.3 (1.5-14) months after radiation and 3.3 (0.5-5) months after the onset or aggravation of RD. Histologically 4 tumors showed 50-100% necrosis without any mitotic activity. Thus local tumor control after GKR appeared sufficient regardless of RD.
Aggravation or development of exudative RD after GKR does not necessarily entail treatment failure. Therefore, retinal reattachment surgery in persistent exudative RD may be an option to preserve the eye.
本研究旨在报告伽玛刀放射治疗（GKR）后持续性渗出性视网膜脱离（RD）的葡萄膜黑色素瘤患者的临床和病理发现。
回顾性研究。
2004 年至 2006 年，对 19 例葡萄膜黑色素瘤患者进行了 GKR，其中 5 例发生持续性渗出性 RD。这 5 例患者的初始最大基底肿瘤直径平均为 14.4±1.9mm，肿瘤高度平均为 9.2±1.0mm。给予 40-50Gy 的边缘剂量放射治疗。GKR 后平均 3（1-10）个月 RD 出现或加重。2 例患者接受了眼球摘除术，其余 3 例患者接受了经玻璃体切除术和硅油填充的视网膜内切除术联合视网膜复位手术切除肿瘤。这些手术平均在放射治疗后 6.3（1.5-14）个月和 RD 发生或加重后 3.3（0.5-5）个月进行。组织学检查显示 4 个肿瘤有 50-100%的坏死而没有任何有丝分裂活动。因此，即使出现 RD，GKR 后的局部肿瘤控制似乎也是足够的。
GKR 后渗出性 RD 的加重或发展不一定意味着治疗失败。因此，在持续性渗出性 RD 中进行视网膜复位手术可能是保留眼球的一种选择。
