Kühn U, Petersen I, Strobel J
Klinik für Augenheilkunde, Universitätsklinikum Jena.
Klin Monbl Augenheilkd. 2013 Dec;230(12):1230-7. doi: 10.1055/s-0033-1350929. Epub 2013 Dec 10.
Uveal melanoma is the most common primary intraocular malignancy in adults. Iris melanomas are rare tumours: they account for 2-3 % of all uveal melanomas. The clinical differentiation between benign iris nevi and malignant iris melanomas can be difficult.
The aim of this study was the registration, analysis and observation of all patients with tumours of the anterior uvea who had been treated surgically between 1992 and 2011 at the ophthalmic department of the University Hospital of Jena. 40 patients were analysed and compared concerning their preoperative states, operating methods including complications, histological results, postoperative function, subjective complaints as well as the risk of metastasis and the associated dependence on mortality of the dignity of the tumours. In this time period 26 patients has been observed in a follow-up visit. Patients with a malignant tumour were offered an examination.
The histological examination revealed for 24 patients a benign tumour and for 16 patients a malignant tumour. After an exact analysis of multiple parameters there was only a statistically significant difference in the preoperative visual acuity (p = 0.025) and in the tumour size (p = 0.011) between the two analysed groups of patients. The rate of serious postoperative complications was 11.4 %. One fourth of the patients complained of subjective problems after the surgical intervention. In the follow-up visit a visual acuity of 0.5 or better was achieved in 68 % of all interventions.
A reliable diagnosis is only possible after histological examination. The analysed parameters can only give indications for the dignity of the tumour. The strategy of the ophthalmic department of the University Hospital of Jena to remove a tumour of uncertain dignity at an early state makes sense, because there are few postoperative complications, few patients complain about subjective problems and the chances for achieving good visual acuity are high.
葡萄膜黑色素瘤是成人中最常见的原发性眼内恶性肿瘤。虹膜黑色素瘤是罕见肿瘤：占所有葡萄膜黑色素瘤的2%-3%。良性虹膜痣与恶性虹膜黑色素瘤的临床鉴别可能存在困难。
本研究的目的是对1992年至2011年期间在耶拿大学医院眼科接受手术治疗的所有前葡萄膜肿瘤患者进行登记、分析和观察。对40例患者的术前状态、手术方法（包括并发症）、组织学结果、术后功能、主观症状以及转移风险和肿瘤性质对死亡率的相关影响进行了分析和比较。在此期间，对26例患者进行了随访观察。为患有恶性肿瘤的患者提供了检查。
组织学检查显示，24例患者为良性肿瘤，16例患者为恶性肿瘤。在对多个参数进行精确分析后，两组分析患者之间仅在术前视力（p = 0.025）和肿瘤大小（p = 0.011）方面存在统计学上的显著差异。术后严重并发症发生率为11.4%。四分之一的患者在手术干预后抱怨有主观问题。在随访中，所有干预中有68%的患者视力达到或优于0.5。
只有经过组织学检查才能做出可靠的诊断。所分析的参数只能为肿瘤的性质提供线索。耶拿大学医院眼科早期切除性质不确定肿瘤的策略是合理的，因为术后并发症少，很少有患者抱怨主观问题，且获得良好视力的机会很高。
