Summanen P, Immonen I, Kivelä T, Tommila P, Heikkonen J, Tarkkanen A
Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Ophthalmic Surg Lasers. 1995 Sep-Oct;26(5):449-60.
To analyze the overall visual outcome in 100 consecutive eyes with malignant uveal melanoma irradiated with ruthenium-106 plaques between 1981 and 1991.
The follow-up ranged from 4 months to 10.1 years (median 3.0 years). Scattergrams of equal follow-up periods, life-table survival analysis, and Cox's proportional hazards analysis were used to analyze visual outcome.
VA increased for some time in 14 eyes. By 3 years, VA of at least 20/70, 20/200, counting fingers, and light perception were retained in 27%, 41%, 67% and 82% of eyes, respectively. Macular pathology cause loss of reading vision; neovascular glaucoma or enucleation caused loss of light perception. In univariate analysis, large tumor size (height > 5 mm or TNM class T3) predicted visual loss of all VA levels. For the loss of light perception, the tumor's largest basal diameter > 15 mm reached significance. In Cox's multivariate analysis tumor height > 5 mm was the only significant independent risk indicator for loss of VA levels 20/70 and 20/200. For the level CF, largest basal tumor diameter also reached significance, but location of the tumor within 1 disc diameter of the optic disc, either alone or in addition to the fovea, had the greatest risk ratio (6.3, 95% CI 4.1-9.8). For losing light perception, large TNM size (T3) was the strongest risk indicator (risk ratio 10.0; 95% CI 4.5-22.5), followed by proximity of the tumor to the optic disc (risk ratio 4.3, 95% CI 2.4-7.8).
Ruthenium brachytherapy may retain vision in an eye with a malignant melanoma of the uvea for a considerable period of time. The data presented are useful in patient counseling and allow comparison to subsequent series.
分析1981年至1991年间连续100例接受钌-106敷贴器照射的脉络膜恶性黑色素瘤患者的总体视力预后。
随访时间为4个月至10.1年（中位时间3.0年）。采用等随访期散点图、寿命表生存分析和Cox比例风险分析来分析视力预后。
14只眼的视力在一段时间内有所提高。到3年时，分别有27%、41%、67%和82%的眼保留了至少20/70、20/200、数指和光感的视力。黄斑病变导致阅读视力丧失；新生血管性青光眼或眼球摘除导致光感丧失。单因素分析中，肿瘤体积大（高度>5mm或TNM分期T3期）预示所有视力水平的视力丧失。对于光感丧失，肿瘤最大基底直径>15mm具有统计学意义。在Cox多因素分析中，肿瘤高度>5mm是视力水平20/70和20/200丧失的唯一显著独立风险指标。对于数指水平，肿瘤最大基底直径也具有统计学意义，但肿瘤位于视盘1个视盘直径范围内（单独或除黄斑外）的风险比最大（6.3，95%可信区间4.1 - 9.8）。对于丧失光感，TNM分期大（T3期）是最强的风险指标（风险比10.0；95%可信区间4.5 - 22.5），其次是肿瘤与视盘的距离（风险比4.3，95%可信区间2.4 - 7.8）。
钌近距离放疗可在相当长一段时间内保留脉络膜恶性黑色素瘤患眼的视力。所呈现的数据对患者咨询有用，并可与后续系列进行比较。
