Hamza Hany S, Elnahry Ayman G
Department of Ophthalmology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11956, Egypt.
Int J Retina Vitreous. 2022 Jul 6;8(1):46. doi: 10.1186/s40942-022-00395-z.
To report the use of short-term perfluorocarbon liquid (ST-PFCL) tamponade following choroidal melanoma endoresection.
Patients with medium to large choroidal melanomas not amenable to primary Ruthenium-106 brachytherapy underwent choroidal melanoma endoresection following gamma knife radiosurgery. During surgery, a complete vitrectomy was performed followed by PFCL injection, then a retinectomy with endoresection of the melanoma and underlying choroid was done. Complete PFCL filling was then achieved, and laser barrage surrounding the retinectomy was done. A Ruthenium-106 plaque was then inserted. Postoperatively, supine positioning was maintained for three days followed by plaque and PFCL removal with silicone oil injection. Several months later, silicone oil was removed.
Four eyes of 4 patients underwent endoresection with ST-PFCL tamponade. Mean height of tumor was 8.6 ± 0.85 mm, while mean maximal basal diameter was 11.5 ± 1.1 mm. Mean preoperative logMAR best corrected visual acuity (BCVA) was 1.76 ± 0.18. All patients underwent preoperative gamma knife radiosurgery and postoperative brachytherapy. There were no major intraoperative or postoperative complications. All patients underwent silicone oil injection with PFCL/plaque removal after 3 days, while silicone oil was removed after 4 ± 1.2 months. Mean postoperative logMAR BCVA 3 months following oil removal was 0.89 ± 0.22 (p = 0.02). Mean follow-up duration was 17 ± 2.8 months. No patient developed local tumor recurrence, distant metastases, or vitreoretinal complications by final visit.
ST-PFCL tamponade may reduce the risk of intraoperative and postoperative complications associated with choroidal melanoma endoresection.
报告脉络膜黑色素瘤内切除术后短期全氟碳液体（ST-PFCL）填塞的应用情况。
不适合原发性钌-106近距离放射治疗的中至大型脉络膜黑色素瘤患者，在伽玛刀放射外科治疗后接受脉络膜黑色素瘤内切除术。手术过程中，先进行完全玻璃体切除术，然后注入PFCL，接着进行视网膜切除术，同时切除黑色素瘤及下方脉络膜。随后实现PFCL完全填充，并在视网膜切除术周围进行激光光凝。然后插入钌-106敷贴器。术后，保持仰卧位3天，之后取出敷贴器和PFCL并注入硅油。数月后，取出硅油。
4例患者的4只眼接受了ST-PFCL填塞的内切除术。肿瘤平均高度为8.6±0.85毫米，平均最大基底直径为11.5±1.1毫米。术前平均logMAR最佳矫正视力（BCVA）为1.76±0.18。所有患者均接受了术前伽玛刀放射外科治疗和术后近距离放射治疗。术中及术后均未出现重大并发症。所有患者在3天后接受了硅油注入并取出PFCL/敷贴器，4±1.2个月后取出硅油。取出硅油后3个月的平均术后logMAR BCVA为0.89±0.22（p = 0.02）。平均随访时间为17±2.8个月。最后一次随访时，没有患者出现局部肿瘤复发、远处转移或玻璃体视网膜并发症。
ST-PFCL填塞可能降低脉络膜黑色素瘤内切除术相关的术中及术后并发症风险。
