Peyman G A, Gremillion C M
LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112.
Jpn J Ophthalmol. 1989;33(4):458-71.
Management of intraocular tumors, specifically uveal melanoma, is a matter of controversy. The treatment of these ocular neoplasms varies from observation to enucleation, irradiation (cobalt plaque and proton-helium particle) and eye wall resection. Over the last 18 years, we have developed two techniques for surgical resection of intraocular tumors. An encircling laser photocoagulation and limited scatter photocoagulation with laser precede both procedures. The operation is performed under hypotensive anesthesia in both techniques. The external approach is used for anteriorly located tumors (ciliary body and anterior choroidal lesions) and makes use of an eye basket to stabilize the operation area. A partial dissection of the sclera is performed, then the tumor is removed en bloc with the sclera, choroid and retina. The remaining sclera is resutured to cover the resected area. A modification of this technique is used for a limited excision of choroidal and retinal tissue for the purpose of biopsy and tissue analysis. The internal approach (developed four years ago) has been successfully used for removal of malignant and benign lesions located posterior to the equator and around the optic nerve. This technique uses vitrectomy instrumentation in addition to endolaser. Detailed surgical technique and results achieved in both procedures are described.
眼内肿瘤，特别是葡萄膜黑色素瘤的治疗存在争议。这些眼部肿瘤的治疗方法从观察到眼球摘除、放疗（钴板和质子 - 氦粒子）以及眼壁切除术不等。在过去的18年里，我们开发了两种眼内肿瘤手术切除技术。在这两种手术之前都要进行环形激光光凝和有限散射激光光凝。两种技术均在降压麻醉下进行。外部入路用于治疗位于前部的肿瘤（睫状体和脉络膜前部病变），并使用眼筐来稳定手术区域。先进行巩膜部分剥离，然后将肿瘤与巩膜、脉络膜和视网膜整块切除。剩余的巩膜重新缝合以覆盖切除区域。这种技术的一种改良方法用于有限切除脉络膜和视网膜组织以进行活检和组织分析。内部入路（四年前开发）已成功用于切除位于赤道后方和视神经周围的恶性和良性病变。除了眼内激光外，该技术还使用玻璃体切除器械。文中描述了两种手术的详细手术技术和取得的结果。
