Seddon J M, Gragoudas E S, Egan K M, Glynn R J, Munzenrider J E, Austin-Seymour M, Goitein M, Verhey L, Urie M, Koehler A
Ophthalmology. 1987 Apr;94(4):354-61. doi: 10.1016/s0161-6420(87)33439-6.
Proximity to the disc and fovea is a risk factor for visual loss after proton beam irradiation of uveal melanomas. Of 562 eyes treated over a 10-year period with pretreatment visual acuity of 20/200 or better, 363 (64.6%) contained tumors within 2 disc diameters (DD) of the disc or fovea. Rates of visual loss after treatment to worse than 20/200 and causes of visual decline were evaluated using Kaplan-Meier analysis. Cumulative rates of visual loss among subjects with tumors near the disc or fovea were 33 and 47% 1 and 2 years after treatment compared to 17 and 28%, respectively, for subjects with tumors located farther from both structures. The leading cause of visual loss in the first year among eyes with tumors near the disc or fovea was retinal detachment. Controlling for other predictors of visual loss to worse than 20/200, location near the disc or fovea was independently related to visual loss primarily due to retinal detachment, cataract, and radiation retinopathy. Despite the unfavorable location of these tumors, over half of patients with 20/200 or better pretreatment visual acuity had useful vision 2 years after treatment.
在质子束照射葡萄膜黑色素瘤后，肿瘤距视盘和黄斑中心凹的距离是导致视力丧失的一个危险因素。在10年期间接受治疗的562只眼中，治疗前视力为20/200或更好，其中363只眼（64.6%）的肿瘤位于距视盘或黄斑中心凹2个视盘直径（DD）范围内。使用Kaplan-Meier分析评估治疗后视力下降至低于20/200的发生率以及视力下降的原因。与肿瘤距这两个结构较远的受试者相比，肿瘤靠近视盘或黄斑中心凹的受试者在治疗后1年和2年的视力丧失累积发生率分别为33%和47%，而后者分别为17%和28%。在肿瘤靠近视盘或黄斑中心凹的眼中，第一年视力丧失的主要原因是视网膜脱离。在控制了其他导致视力下降至低于20/200的预测因素后，靠近视盘或黄斑中心凹的位置与主要因视网膜脱离、白内障和放射性视网膜病变导致的视力丧失独立相关。尽管这些肿瘤位置不佳，但超过一半治疗前视力为20/200或更好的患者在治疗后2年仍有有用视力。
