Gündüz Kaan, Karslioğlu Melisa Zişan, Köse Kenan
Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
Middle East Afr J Ophthalmol. 2011 Apr;18(2):183-8. doi: 10.4103/0974-9233.80711.
To evaluate the role of primary transpupillary thermotherapy (TTT) in the treatment of choroidal melanocytic lesions.
Retrospective chart review of 24 patients (24 eyes) with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization.
The mean initial tumor basal diameter was 6.6 (3.0-10.0) mm and the mean initial tumor thickness was 3.0 (1.0-5.0) mm. The mean number of TTT sessions was 2.5 (1-6). The mean decrease in tumor thickness was 1.2 mm (from 3.0 to 1.8 mm) at a mean follow-up of 22.7 (range 3-90) months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients (20.8%)], focal cataract [5 patients (20.8%)], iris atrophy [4 patients (16.6%)] and posterior synechia [4 patients (16.6%)]. There was no significant difference in the complication rate with respect to tumor thickness >3 mm versus tumor thickness ≤3 mm and juxtapapillary versus nonjuxtapapillary location (Fisher's exact test, P>0.05). Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes (8.3%) were enucleated because of neovascular glaucoma and one eye (4.1%) was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients (87.5%). One patient (4.1%) with extraocular tumor recurrence developed liver metastasis and expired.
Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved.
评估原发性经瞳孔温热疗法（TTT）在脉络膜黑素细胞性病变治疗中的作用。
对24例（24只眼）脉络膜黑素细胞性病变患者进行回顾性病历分析，其中包括20例脉络膜黑色素瘤和4例接受原发性TTT治疗的脉络膜痣。接受原发性TTT治疗的脉络膜痣病例要么显示出发展为早期黑色素瘤的危险因素，要么存在脉络膜新生血管形成。
肿瘤初始基底平均直径为6.6（3.0 - 10.0）mm，初始肿瘤厚度平均为3.0（1.0 - 5.0）mm。TTT治疗平均次数为2.5（1 - 6）次。平均随访22.7（3 - 90）个月时，肿瘤厚度平均下降1.2 mm（从3.0 mm降至1.8 mm）。在LogMar视力表上，视力稳定在1.0。50%的患眼出现并发症。最常见的并发症为玻璃体积血[5例患者（20.8%）]、局限性白内障[5例患者（20.8%）]、虹膜萎缩[4例患者（16.6%）]和虹膜后粘连[4例患者（16.6%）]。肿瘤厚度>3 mm与≤3 mm以及靠近视乳头与非靠近视乳头部位的并发症发生率无显著差异（Fisher精确检验，P>0.05）。Kaplan - Meier曲线显示，原发性TTT治疗后，9%的患眼在1年内复发，27%的患眼在5年内复发。2只眼（8.3%）因新生血管性青光眼而摘除眼球，1只眼（4.1%）因眼外肿瘤复发而眼眶内容剜除术。21例患者（87.5%）实现了眼球保留。1例（4.1%）眼外肿瘤复发患者发生肝转移并死亡。
尽管TTT可能对小脉络膜黑素细胞性病变的治疗有用，但即使已形成扁平的脉络膜视网膜瘢痕，高并发症和复发率仍需要在原发性TTT治疗后对患者进行密切监测。
