用于与结膜黑色素瘤治疗相关的巩膜软化症的睑板结膜瓣。

Tarsoconjunctival flap for scleromalacia related to treatments for conjunctival melanoma.

作者信息

Finger Paul T, Reddy Harsha S, Maheshwari Abhilasha

机构信息

Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York City, New York, USA.

The Divisions of Ophthalmic Plastic Surgery and Ocular Oncology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.

出版信息

Am J Ophthalmol Case Rep. 2023 Jan 18;29:101805. doi: 10.1016/j.ajoc.2023.101805. eCollection 2023 Mar.

DOI:10.1016/j.ajoc.2023.101805

PMID:36714017

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9881042/

Abstract

PURPOSE

To describe the use of a tarsoconjunctival pedicle flap for the repair of scleral melt secondary to treatment of conjunctival melanoma.

OBSERVATION

A 67-year-old woman developed progressive scleromalacia after multiple treatments for an American Joint Committee on Cancer cT2d category conjunctival melanoma. Prior to referral, she underwent synchronous topical chemotherapy (interferon, 5-fluorouracil, mitomycin). Then, incomplete tumor regression led to excision with adjuvant cryotherapy. Lastly, systemic metastasis treated with systemic immunotherapy provided durable remission. However, her multiple treatments (e.g., topical chemotherapy, resection, cryotherapy) were associated with progressive nasal bulbar scleromalacia treated by conjunctival advancement and amniotic membrane grafts. Sclera reinforcement was achieved after a tarsoconjunctival flap was affixed to the eye to cover, and thus vascularize the scleral defect. The tarsoconjunctival flap provided 5 years of tectonic support.

CONCLUSIONS AND IMPORTANCE

Tarsoconjunctival pedicle flaps can provide scleral integrity for a patient with progressive scleral melting.

摘要

目的

描述睑板结膜带蒂皮瓣在修复结膜黑色素瘤治疗后继发巩膜溶解中的应用。

观察结果

一名67岁女性在接受美国癌症联合委员会cT2d级结膜黑色素瘤的多次治疗后出现进行性巩膜软化。在转诊前，她接受了同步局部化疗（干扰素、5-氟尿嘧啶、丝裂霉素）。随后，肿瘤不完全消退导致行辅助冷冻治疗的切除术。最后，采用全身免疫疗法治疗全身转移获得了持久缓解。然而，她的多次治疗（如局部化疗、切除、冷冻治疗）与通过结膜推进和羊膜移植治疗的进行性鼻侧球结膜巩膜软化有关。在将睑板结膜瓣固定于眼部以覆盖并使巩膜缺损血管化后，实现了巩膜加固。睑板结膜瓣提供了5年的结构支撑。