钌 106 放射性敷贴器巩膜表面敷贴治疗脉络膜后型黑色素瘤的长期疗效观察。
Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma.
机构信息
Ocular Oncology Service, Moorfields Eye Hospital, London, UK.
Ocular Oncology Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
出版信息
Eye (Lond). 2023 Apr;37(5):959-965. doi: 10.1038/s41433-022-01944-4. Epub 2022 Feb 9.
BACKGROUND
To assess the long-term visual outcomes in patients with posteriorly located choroidal melanoma treated with ruthenium plaque brachytherapy between January 2013 and December 2015.
METHODS
A retrospective review was conducted on consecutive patients treated with ruthenium plaque brachytherapy for post-equatorial choroidal melanoma with available Snellen visual acuity before and after treatment, and the development and treatment of radiation complications.
RESULTS
There were 219 patients with posterior choroidal melanoma treated with ruthenium plaque brachytherapy. Median follow up was 56.5 months, range 12-81 months. Final visual acuity was ≥6/12 in 97 (44.3%) patients, 6/12 to 6/60 in 57 (26.0%), <6/60 in 55 (25.1%) and 10 (4.6%) eyes were enucleated. Radiation maculopathy was the most common radiation complication encountered, occurring in 53 (24.2%) patients. Of these, final visual acuity was 6/12 in 10 patients (18.9%), 6/12 to 6/60 in 26 (49.1%), <6/60 in 16 (30.2%) and 1 eye (1.9%) was enucleated. Twenty-five (47%) with radiation maculopathy were treated with intravitreal anti-angiogenic therapy, 27 (51%) were monitored and one (2%) was treated with scatter photocoagulation. Eyes treated with intravitreal anti-angiogenic therapy had better final vision than those observed or treated with retinal laser (chi-square, p = 0.04). On multivariate analysis, close proximity to the optic nerve and fovea, and large or notched plaque type was associated with final vision worse than 6/12.
CONCLUSION
Most patients treated with ruthenium plaque brachytherapy for posterior choroidal melanoma retain 6/60 vision, with almost half retaining 6/12 vision at long term follow up.
背景
评估 2013 年 1 月至 2015 年 12 月期间接受钌 106 放射性敷贴治疗的后极部脉络膜黑色素瘤患者的长期视力结果。
方法
对连续接受钌 106 放射性敷贴治疗的赤道后段脉络膜黑色素瘤患者进行回顾性分析，这些患者在治疗前后均有 Snellen 视力，并记录了视力的发展和放射性并发症的治疗情况。
结果
共有 219 例后极部脉络膜黑色素瘤患者接受钌 106 放射性敷贴治疗。中位随访时间为 56.5 个月，范围为 12-81 个月。最终视力≥6/12 的患者有 97 例（44.3%），6/12 至 6/60 的患者有 57 例（26.0%），<6/60 的患者有 55 例（25.1%），10 例（4.6%）患者行眼球摘除术。放射性黄斑病变是最常见的放射性并发症，共发生在 53 例（24.2%）患者中。其中，最终视力为 6/12 的患者有 10 例（18.9%），6/12 至 6/60 的患者有 26 例（49.1%），<6/60 的患者有 16 例（30.2%），1 例（1.9%）患者行眼球摘除术。有 25 例（47%）放射性黄斑病变患者接受了眼内抗血管生成治疗，27 例（51%）患者接受了观察，1 例（2%）患者接受了散在光凝治疗。接受眼内抗血管生成治疗的患者最终视力优于观察或视网膜激光治疗的患者（卡方检验，p=0.04）。多因素分析显示，视神经和黄斑附近、大斑块或切迹型与最终视力<6/12 有关。
结论
大多数接受钌 106 放射性敷贴治疗的后极部脉络膜黑色素瘤患者保留了 6/60 的视力，近一半的患者在长期随访中保留了 6/12 的视力。
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