Pathan Arif H K, Barash Alexander, Tena Lawrence B, Finger Paul T
1 Department of Ophthalmology, Ocular Tumor Service, The New York Eye and Ear Infirmary of Mount Sinai, New York, New York - USA.
3 Departments of Ophthalmology and Radiation Oncology, Mount Sinai Icahn School of Medicine, New York, New York - USA.
Eur J Ophthalmol. 2018 Jan;28(1):119-122. doi: 10.5301/ejo.5001046.
To provide a clinical description of the long-term outcome of a Pd plaque-irradiated ciliary body melanoma with extrascleral extension while attempting to preserve a subadjacent glaucoma filtering bleb.
A 75-year-old woman with pseudoexfoliative glaucoma for 17 years, 16 years status post argon laser trabeculoplasty, and 15 years status post trabeculectomy in the left eye, was diagnosed with an ipsilateral ciliary body melanoma with visible extrascleral extension. Treatment involved insertion of a Pd radioactive plaque over the functioning trabeculectomy, with removal 7 days later. At plaque insertion, amniotic membrane grafts were used to cover the plaque and protect the filtering site.
The tumor was successfully treated without clinical evidence of harm to the filtering bleb, with resultant stable intraocular pressure. However, the patient developed blebitis 1.5 years later. Though it resolved with topical antibiotic therapy, the bleb became less succulent. Two years postoperatively, she developed a spontaneous hyphema that resolved after one injection of transscleral bevacizumab 1.25 mg. Her tumor continually regressed in thickness. Without additional glaucoma surgery, her intraocular pressure remained well-controlled on topical medications for 6 years.
Ciliary body melanoma with minimal extrascleral extension beneath a functioning filtering bleb can be treated using radioactive plaque therapy. In this case, we were able to achieve both tumor regression and glaucoma control by covering the plaque with an amniotic membrane graft.
对接受钯斑块照射治疗且伴有巩膜外扩展的睫状体黑色素瘤的长期预后进行临床描述，同时尝试保留相邻的青光眼滤过泡。
一名75岁女性，左眼患假性剥脱性青光眼17年，行氩激光小梁成形术16年，小梁切除术15年，被诊断为同侧睫状体黑色素瘤且有明显的巩膜外扩展。治疗方法是在仍在发挥作用的小梁切除部位上方植入钯放射性斑块，7天后取出。在植入斑块时，使用羊膜移植片覆盖斑块并保护滤过部位。
肿瘤得到成功治疗，没有临床证据表明滤过泡受到损害，眼压由此保持稳定。然而，患者在1.5年后发生了滤过泡炎。尽管局部抗生素治疗使其消退，但滤过泡变得不再饱满。术后两年，她出现了自发性前房积血，注射一次1.25毫克的经巩膜贝伐单抗后积血消退。她的肿瘤厚度持续缩小。在未进行额外青光眼手术的情况下，她的眼压在局部用药治疗下6年保持良好控制。
对于在仍在发挥作用的滤过泡下方有最小程度巩膜外扩展的睫状体黑色素瘤，可采用放射性斑块疗法进行治疗。在本病例中，我们通过用羊膜移植片覆盖斑块，实现了肿瘤消退和青光眼控制。
