Egan K M, Gragoudas E S, Seddon J M, Glynn R J, Munzenreider J E, Goitein M, Verhey L, Urie M, Koehler A
Department of Ophthalmology, Harvard Medical School, Boston, MA.
Ophthalmology. 1989 Sep;96(9):1377-82; discussion 1382-3. doi: 10.1016/s0161-6420(89)32738-2.
Enucleation after proton beam irradiation of uveal melanomas occurred in 64 (6.4%) of 994 eyes with a median follow-up time of 2.7 years. The median time between irradiation and enucleation in the 64 enucleated eyes was 13 months. The probability of retaining the eye was 95 and 90%, 2 and 5 years postirradiation, respectively. Three percent of eyes were enucleated during posttreatment year 1, and the yearly rate was 1% by the fourth year. No patient had enucleation later than 5 1/2 years posttreatment. The complication most likely to result in enucleation was neovascular glaucoma although this was frequently managed without enucleation. Other common reasons for enucleation were documented or suspected tumor growth and complete retinal detachment with associated loss of vision. The leading risk factors for enucleation were anterior tumor margin involving the ciliary body, tumor height greater than 8 mm, and proximity of the tumor to the fovea. Based on the presence or absence of these factors, 5-year eye retention rates were 99, 92, and 76% for low-, moderate-, and high-risk groups, respectively. Thus, the probability of eye retention after proton beam irradiation is high even among those at greatest risk of enucleation.
994只眼睛接受质子束照射治疗葡萄膜黑色素瘤后，64只（6.4%）眼睛发生眼球摘除，中位随访时间为2.7年。64只接受眼球摘除的眼睛，从照射到眼球摘除的中位时间为13个月。照射后2年和5年，保留眼球的概率分别为95%和90%。治疗后第1年有3%的眼睛接受了眼球摘除，到第4年，每年的摘除率为1%。没有患者在治疗后5年半后接受眼球摘除。最有可能导致眼球摘除的并发症是新生血管性青光眼，不过这种情况常常无需进行眼球摘除即可处理。其他常见的眼球摘除原因是记录在案的或怀疑的肿瘤生长以及伴有视力丧失的完全性视网膜脱离。眼球摘除的主要危险因素是肿瘤前缘累及睫状体、肿瘤高度大于8 mm以及肿瘤靠近黄斑。根据这些因素的有无，低风险、中风险和高风险组的5年眼球保留率分别为99%、92%和76%。因此，即使在那些眼球摘除风险最高的患者中，质子束照射后保留眼球的概率也很高。
