Hamal Diwa, Limbu Ben, Sthapit Purnima Rajkarnikar, Pradhan Eli, Shrestha Reshmi, Saiju Rohit
Biratnagar Eye Hospital, Biratnagar.
Nepal J Ophthalmol. 2019 Jan;11(21):64-73. doi: 10.3126/nepjoph.v11i1.25422.
Choroidal melanomas are diagnosed in approximately 6 out of one million Americans per year, and although their incidence is low, they are the most common primary intraocular tumor in adults.
Choroidal melanoma is rare tumors and till date no such reports with sclera involvement has been reported from Nepal. It is a prospective case series. The aim of this study is for awareness of the severity of the Choroidal melanoma and it's management. Besides, it is also to study the demography, presentation, histopathological variations and management of cases of choroidal melanoma. All the consecutive cases of Choroidal melanoma presenting between Jan 2017 to May 2018 and those who were within the inclusion criteria were included in this study.
There were eight patients, five male and three female, within age range of 18-73, median age was 47. All patients presented with decreased vision ranging from 6/24 to PL of less then three months to 2 years duration. Fund us showed choroidal mass associated with Vitreous hemorrhage (VH), and retinal detachment (RD). Two patients were managed with enucleation with External beam radiotherapy (EBRT). Four underwent only enucleation. One patient with lesion size less then 10mm under went plaque brachy therapy. One patient underwent initially Plaque brachy therapy but later had to undergo Enucleation. Histopathological examination (HPE) of enucleated patient revealed epitheloid cell melanoma grade three in four and Spindle cell melanoma in three patients. Each one patient of epitheloid cell melanoma and spindle cell melanomahad scleral involvement. Indication for radiotherapy was scleral involvement.
With 8 cases of Choroidal melanoma in a single year in a single hospitalgives us a clue that there may be much more undiagnosed cases of Choroidal melanomain Nepal that should be taken seriously. Going for annual eye examination with routine dilated fund us exams can help in prevention and early diagnosis of this life and sight threatening condition and to reduce the mortality rate.
每年每百万美国人中约有6人被诊断出患有脉络膜黑色素瘤，尽管其发病率较低，但却是成人中最常见的原发性眼内肿瘤。
脉络膜黑色素瘤是罕见肿瘤，迄今为止尼泊尔尚未有巩膜受累的相关报道。这是一个前瞻性病例系列研究。本研究的目的是提高对脉络膜黑色素瘤严重性及其治疗的认识。此外，还要研究脉络膜黑色素瘤病例的人口统计学、临床表现、组织病理学变异及治疗情况。2017年1月至2018年5月期间所有连续的脉络膜黑色素瘤病例以及符合纳入标准的患者均纳入本研究。
共有8例患者，5例男性，3例女性，年龄在18 - 73岁之间，中位年龄为47岁。所有患者均有视力下降，视力范围从6/24到光感，病程从不到三个月到两年不等。眼底检查显示脉络膜肿物伴有玻璃体出血（VH）和视网膜脱离（RD）。2例患者接受了眼球摘除术并联合外照射放疗（EBRT）。4例仅接受了眼球摘除术。1例病变大小小于10mm的患者接受了敷贴近距离放疗。1例患者最初接受了敷贴近距离放疗，但后来不得不接受眼球摘除术。眼球摘除患者的组织病理学检查（HPE）显示，4例为三级上皮样细胞黑色素瘤，3例为梭形细胞黑色素瘤。上皮样细胞黑色素瘤和梭形细胞黑色素瘤各有1例患者出现巩膜受累。放疗的指征是巩膜受累。
一家医院在一年内出现8例脉络膜黑色素瘤病例，这提示我们尼泊尔可能存在更多未被诊断的脉络膜黑色素瘤病例，应予以重视。每年进行一次扩瞳眼底常规检查有助于预防和早期诊断这种危及生命和视力的疾病，并降低死亡率。
