脉络膜转移癌的经瞳孔温热疗法观察  

Transpupinary thermotherapy for choroidal metastases

作　　者：王明扬[1] 王光璐[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心,北京100730

出　　处：《中国实用眼科杂志》2010年第9期1026-1028,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察经瞳孔温热疗法治疗脉络膜转移癌的临床疗效。方法9例患者中男性2例，女性7例。双眼病人3例，单眼病人6例；共12只眼。年龄37—60岁，平均44．6岁。视力≤0．05者1只眼，0．06。0．2者2只眼，≥0．3者9只眼。转移灶呈黄白色扁平隆起，病灶表面均合并有不同程度的浅脱离。病灶数目为单个者2只跟，2个者3只眼，3个或以上者7只眼。转移灶位于后极部者4只眼，位于黄斑及其周者6只眼，位于视盘周者2只眼。原发病灶为肺及支气管肿瘤者5例；乳腺癌者3例；大肠癌者1例。采用眼底检查、荧光素眼底血管造影及B型超声波作检查。治疗采用经瞳孑L温热疗法。波长810μm；所用能量250～1000mw，平均510mw；光斑大小2．0—3．0mm；曝光时间60s或120s。以转移灶处出现灰白色反应斑为宜。治疗点数2-6个点，平均3．7个点。治疗次数1-6次，平均2．9次。治疗间隔时间1～3个月。其中1例转移灶位于黄斑中心合并维替泊芬（visudyne）光动力治疗。结果经治疗后转移癌处呈扁平瘢痕色素沉着，渗液吸收。视力增进者2只眼；视力不变者4只眼；视力下降者6只眼。视力下降缘于转移灶就在黄斑部或存在黄斑继发病变。观察时间1-32个月，平均9．6个月。结论脉络膜转移癌适宜采用经瞳孔温热疗法。该疗法治疗脉络膜转移癌效果确切而价廉，值得采用。Objective To study the effect of Transpupillary thermotherapy （TTT） On choroidal metastases. Methods Nine cases were enrolled in the study, male 2 and female 7 cases. Bilateral eyes were affected in 3 cases. The age of cases was 37-60yrs with averaged at 44.6 yrs. The visual acuity was ≤0.05 in 1 eye, 0.06-0.2 in 2 eyes, 0.3-1.0 in 9 eyes. The metastatic tumor showed as a yellow-white flat lesions with retinal de- tachment in different extent on their surfaces. The number of the lesions was single in 2 eyes, 2 in 3 eyes, ≥ 3 in 7 eyes. The location of the lesions was at the posterior pole in 4 eyes, at the macular and its surrounding in 6 eyes, around the disc in 2 eyes. The primary tumor was located at the lung and bronchus in 5 cases, at the breast in 3 cases, at the large intestine in 1 case. Indirect ophthalmoscope, fundus fluorescein angiography （FFA）, ultrasound （A, B） and optical coherence tomography （OCT） were used for exam. Treatment was delivered via slit lamp using an 810 nm diode laser （Iridex） with 250 to 1000 row, with average 510 mw; the spot size was 2.0-3.0ram, duration ranged from 60 s to 120 s. The lesions just turned into pale-white appearance after treatment. The number of laser spot was 2-6 with average 3.7 spots. The session for management was 1-6 with average 2.9. The interval between 2 sessions was 1-3 months. The lesion just underlying the fovea was combined with photodynamic therapy （visudyne） in 1 case. Results The lesions turned into a flat scar with pigmentation and fluid absorption after treatment. The visual acuity was improved in 2 eases, unchanged in 4 cases, declined in 6 cases. The visual decline was caused by the lesion underneath the fovea and secondary macular lesions. The fellow-up was 1-32 months with average 9.6 monthsl Conclusions TTT is rational for choroidal metastatic lesions and has definite effect with low cost. It is worth doing in the future. Early discovering and managing the lesions helped to protect the visual acuity of the patients.

关 键 词：脉络膜转移癌 经瞳孔温热疗法 光动力疗法 

分 类 号：R774.5[医药卫生—眼科]