Pham Chau M, Custer Philip L, Couch Steven M
a Department of Ophthalmology and Visual Sciences , Washington University in St. Louis , St Louis , Missouri , USA.
Orbit. 2017 Dec;36(6):422-427. doi: 10.1080/01676830.2017.1337183. Epub 2017 Aug 16.
We investigated operative course and post-operative findings of patients undergoing primary enucleation for uveal melanoma versus those requiring secondary enucleation after brachytherapy. A retrospective chart review was performed with IRB approval on patients receiving treatment for uveal melanoma. Patients with enucleation as initial treatment and patients enucleated after plaque brachytherapy were analyzed for demographic data, operative course, and post-enucleation outcome. Further cause analysis for secondary enucleations was investigated. No significant difference was seen in age, laterality, or gender between the primarily enucleated (n = 54) and secondarily enucleated (n = 34) groups. Greater difficulty with surgery was noted in 28/32 (87.5%) of secondary enucleations compared to 1/54 (1.8%) of primary enucleations (p < 0.0001). Operative time was >2 hours in 3/51 (6%) of primary enucleations (vs. 8 of 32, 25%, p = 0.02). Average implant size was similar in the 2 groups (20.6 mm), however 2/34 (6%) of secondary enucleations required dermis fat grafting. Post-enucleation anophthalmic ptosis occurred after 8/49 (16%) of primary cases (vs. 13/30, 43%, p = 0.02) and prosthetic enophthalmos after none (0%) of primary cases (vs. 5/30, 17%, p = 0.006). Class 2 gene expression profile was found in 6/8 (60%) of eyes enucleated for treatment failure. Secondary enucleation performed after plaque brachytherapy was technically more difficult, and had more anophthalmic socket and eyelid complications compared to primary enucleation for uveal melanoma. Primary enucleation may avoid additional surgery and morbidity in a subset of patients with contraindications to plaque brachytherapy.
我们研究了因葡萄膜黑色素瘤接受一期眼球摘除术的患者与接受近距离放射治疗后需要二期眼球摘除术的患者的手术过程及术后结果。在获得机构审查委员会（IRB）批准后，对接受葡萄膜黑色素瘤治疗的患者进行了回顾性病历审查。分析了以眼球摘除术作为初始治疗的患者以及在斑块近距离放射治疗后接受眼球摘除术的患者的人口统计学数据、手术过程及眼球摘除术后的结果。对二期眼球摘除术的进一步病因分析也进行了研究。一期眼球摘除组（n = 54）和二期眼球摘除组（n = 34）在年龄、眼别或性别方面未见显著差异。与一期眼球摘除术的1/54（1.8%）相比，二期眼球摘除术的28/32（87.5%）手术难度更大（p < 0.0001）。一期眼球摘除术的3/51（6%）手术时间超过2小时（相比之下，二期眼球摘除术的32例中有8例，占25%，p = 0.02）。两组的平均植入物大小相似（20.6 mm），然而二期眼球摘除术的2/34（6%）需要真皮脂肪移植。一期病例的8/49（16%）在眼球摘除术后发生无眼球上睑下垂（相比之下，二期病例的13/30，占43%，p = 0.02），一期病例无一例（0%）发生义眼台内陷（相比之下，二期病例的5/30，占17%，p = 0.006）。因治疗失败而接受眼球摘除术的8只眼中有6/8（60%）检测到2类基因表达谱。与因葡萄膜黑色素瘤进行的一期眼球摘除术相比，斑块近距离放射治疗后进行的二期眼球摘除术在技术上更困难，且无眼球眼眶和眼睑并发症更多。对于有斑块近距离放射治疗禁忌证的部分患者而言，一期眼球摘除术可避免额外的手术及相关并发症。
