Naumann G O, Rummelt V
Department of Ophthalmology, University of Erlangen-Nürnberg, Germany.
Ophthalmology. 1996 Dec;103(12):2017-27; discussion 2027-8. doi: 10.1016/s0161-6420(96)30392-8.
This study describes the authors' surgical technique and the results in 68 consecutive patients with tumors of the iris and ciliary body involving the angle removed by block excision and tectonic corneoscleral grafting between 1980 and 1995.
There were 41 (60.3%) women and 27 (39.7%) men whose ages ranged from 14 to 85 years (median, 41 years). Follow-up ranged from 0.5 to 15.2 years (median, 6.3 years). Tumors of the iris and ciliary body with chamber angle involvement were removed with a modified block excision consisting of simultaneous en bloc removal of the tumor with adjacent iris and cornea and sclera in full-thickness. The resulting defect of 6 to 20 mm (median, 9.0 mm) diameter is covered with a tectonic corneoscleral graft.
Forty-nine tumors (72.1%) were classified as malignant tumors of the iris and ciliary body. Twenty-one (44.7%) of 47 malignant melanomas showed histologic evidence of scleral invasion of more than one third of scleral thickness. Extrascleral extension of the tumor was present in seven (14.9%) patients with malignant melanomas and in four (21.1%) patients with benign tumors of the iris and ciliary body. The 10-year survival probability of patients with malignant melanomas was 91.4%. The main intraoperative complication was vitreous hemorrhage in 24 (35.3%) patients, and the main postoperative complication was complicated cataract, occurring in 22 (32.3%) patients. Two local tumor recurrences (2.9%) were observed. Four eyes (5.8%) had to be enucleated after block excision. Best-corrected postoperative visual acuity was better than 20/60 in 36 (52.9%) patients.
The authors' results indicate that block excision with tectonic corneoscleral grafting may be the treatment of choice for progressive circumscribed tumors of the iris and ciliary body involving the anterior chamber angle up to 150 degrees of its circumference.
本研究描述了作者的手术技术以及1980年至1995年间连续68例虹膜和睫状体肿瘤累及房角患者接受整块切除联合结构性角巩膜移植术的结果。
患者中女性41例（60.3%），男性27例（39.7%），年龄范围为14至85岁（中位数41岁）。随访时间为0.5至15.2年（中位数6.3年）。对累及房角的虹膜和睫状体肿瘤采用改良整块切除术，即同时整块切除肿瘤及其相邻的虹膜、角膜和全层巩膜。由此产生的直径6至20毫米（中位数9.0毫米）的缺损用结构性角巩膜移植片覆盖。
49例肿瘤（72.1%）被归类为虹膜和睫状体恶性肿瘤。47例恶性黑色素瘤中有21例（44.7%）在组织学上显示巩膜浸润超过巩膜厚度的三分之一。7例（14.9%）恶性黑色素瘤患者和4例（21.1%）虹膜和睫状体良性肿瘤患者存在肿瘤的巩膜外扩展。恶性黑色素瘤患者的10年生存概率为91.4%。术中主要并发症为24例（35.3%）患者发生玻璃体出血，术后主要并发症为22例（32.3%）患者发生复杂性白内障。观察到2例局部肿瘤复发（2.9%）。4只眼（5.8%）在整块切除术后必须摘除眼球。术后最佳矫正视力在36例（52.9%）患者中优于20/60。
作者的结果表明，整块切除联合结构性角巩膜移植术可能是治疗累及前房角圆周达150度的进行性局限性虹膜和睫状体肿瘤的首选治疗方法。
