Section of Ophthalmology, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Ophthalmic Plast Reconstr Surg. 2012 May-Jun;28(3):208-12. doi: 10.1097/IOP.0b013e31824dd9b8.
High-dose radiotherapy can cause contracture of the anophthalmic socket, but the incidence of this complication in patients with enucleation for uveal melanoma has not been reported previously. The authors reviewed the surgical management and outcomes in terms of successful prosthesis wear in patients with severe contracture of the anophthalmic socket treated with high-dose radiotherapy for high-risk uveal melanoma, and they estimated the relative risk of this complication.
The medical records of all consecutive patients enrolled in a prospective uveal-melanoma tissue-banking protocol at the authors' institution who underwent enucleation between January 2003 and December 2010 were reviewed. Patients who underwent adjuvant radiotherapy of the enucleated socket were further studied.
Of the 68 patients enrolled in the prospective tissue-banking protocol, 12 had high-risk histologic features (e.g., extrascleral spread or vortex vein invasion) and were treated with 60 Gy of external beam radiotherapy after enucleation. Five of these patients (41.7%) experienced severe socket contracture precluding prosthesis wear. The median time to onset of contracture following completion of radiotherapy was 20 months. Three patients underwent surgery, which entailed scar tissue release, oral mucous membrane grafting, and socket reconstruction; 2 patients declined surgery. All 3 patients who had surgery experienced significant improvement of socket contracture that enabled patients to wear a prosthesis again.
High-dose radiotherapy after enucleation in patients with uveal melanoma caused severe socket contracture and inability to wear a prosthesis in approximately 40% of patients. Surgical repair of the contracted socket using oral mucous membrane grafting can allow resumption of prosthesis wear.
高剂量放射治疗可导致眼窝凹陷挛缩，但此前尚未报道过葡萄膜黑色素瘤患者眼球摘除术后发生这种并发症的发生率。作者回顾了因高危葡萄膜黑色素瘤行高剂量放射治疗而导致严重眼窝凹陷挛缩患者的手术处理方法和成功佩戴义眼的效果，并估计了这种并发症的相对风险。
作者对本机构一项前瞻性葡萄膜黑色素瘤组织库研究方案中纳入的所有连续患者的病历进行了回顾，这些患者在 2003 年 1 月至 2010 年 12 月期间接受了眼球摘除术。对接受眼球窝切除术后辅助放射治疗的患者进行了进一步研究。
在纳入前瞻性组织库研究方案的 68 例患者中，有 12 例患者具有高危组织学特征（例如，眼外扩散或涡静脉侵犯），在眼球摘除术后接受了 60 Gy 的外照射放射治疗。其中 5 例（41.7%）患者出现严重的眼窝挛缩，无法佩戴义眼。在完成放射治疗后，眼窝挛缩的中位发病时间为 20 个月。3 例患者接受了手术治疗，包括松解疤痕组织、口腔黏膜移植和眼窝重建；2 例患者拒绝手术。所有 3 例接受手术的患者眼窝挛缩均显著改善，从而能够再次佩戴义眼。
葡萄膜黑色素瘤患者眼球摘除术后行高剂量放射治疗可导致严重的眼窝挛缩和约 40%的患者无法佩戴义眼。使用口腔黏膜移植修复挛缩的眼窝可使患者恢复佩戴义眼。
