Rummelt V, Naumann G O, Folberg R, Weingeist T A
Department of Ophthalmology, University of Erlangen-Nürnberg, Germany.
Am J Ophthalmol. 1994 Feb 15;117(2):169-76. doi: 10.1016/s0002-9394(14)73073-9.
We treated four white women with extrascleral extension of suspected ciliary body melanomas with a modified block excision (three patients) or enucleation (one patient). Light and transmission electron microscopy established the diagnosis of ciliary body melanocytoma with extrascleral extension in each patient. Two eyes were irradiated before block excision. Block excision involved simultaneous removal of full-thickness cornea and sclera, iris, and ciliary body with tectonic corneoscleral grafting. The postoperative visual acuity of the three patients treated with a modified block excision was 20/25, 20/50, and 20/60, respectively. No patient experienced local tumor recurrence (30 to 60 months of follow-up). The two irradiated eyes eventually developed radiation-associated complications. After three years the other block excision patient had visual acuity of 20/25. Ciliary body melanocytoma should be included in the differential diagnosis of pigmented tumors of the anterior uvea with extrascleral extension. En bloc excision with simultaneous full-thickness corneoscleral resection is indicated in circumscribed ciliary body tumors, especially when extraocular extension is present.
我们对4例疑似睫状体黑色素瘤巩膜外扩展的白人女性患者进行了治疗，其中3例行改良整块切除术，1例行眼球摘除术。光镜和透射电镜检查确诊每位患者均为伴有巩膜外扩展的睫状体黑素细胞瘤。2只眼在整块切除术前接受了放疗。整块切除术包括同时切除全层角膜和巩膜、虹膜及睫状体，并进行角膜巩膜结构性移植。接受改良整块切除术治疗的3例患者术后视力分别为20/25、20/50和20/60。无患者出现局部肿瘤复发（随访30至60个月）。2只接受放疗的眼睛最终出现了放疗相关并发症。3年后，另1例行整块切除术的患者视力为20/25。睫状体黑素细胞瘤应列入伴有巩膜外扩展的前葡萄膜色素性肿瘤的鉴别诊断中。对于局限性睫状体肿瘤，尤其是存在眼外扩展时，建议行整块切除并同时进行全层角膜巩膜切除术。
