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目的观察脉络膜黑色素瘤敷贴放射治疗的效果。方法采用国产敷贴器对间接检眼镜、荧光素眼底血管造影、吲哚青绿血管造影、B型超声等综合检查确诊的脉络膜黑色素瘤患者21例21只眼进行治疗。棕色实性隆起的圆形或椭圆形肿物位于黄斑周围者7只眼、视盘周围者7只眼、血管弓及附近者5只眼、周边部者2只眼。B型超声检查显示瘤体最大径为13.0mm×11.6mm×9.6mm。视力0.05及其以下者3只眼,0.06至0.2者4只眼,0.3及其以上者14只眼。敷贴器所用核素为125I,设定照射总量为100~120Gy。其中肿瘤位于黄斑、视盘周围的14只眼同时合并采用经瞳孔温热疗法治疗。治疗后观察时间平均12个月,最长者达3年。以B型超声测量瘤体的基底及厚(高)度,若厚度超过原厚度的15%,或基底边缘大于原边缘250mm视为肿物增大。结果治疗后视力下降9只眼,不变10只眼,提高2只眼。瘤体增大6只眼,不变12只眼,缩小3只眼。并发玻璃体积血2只眼,视网膜血管阻塞1只眼,视网膜分支静脉阻塞1只眼,黄斑皱褶1只眼,视网膜出血3只眼,部分性视神经萎缩3只眼,新生血管性青光眼1只眼,眼球摘出3只眼。结论用国产敷贴器对脉络膜黑色素瘤进行放射治疗具有确切的疗效。但对瘤体较厚、肿瘤位于黄斑或视盘旁者效果较差。
Objective To observe the effect of radiotherapy on choroidal melanoma. Methods Twenty-one patients (21 eyes) with choroidal melanoma diagnosed by indirect ophthalmoscope, fundus fluorescein angiography, indocyanine green angiography and B-mode ultrasound were treated with domestic applicator. Brown solid circular raised or oval mass was located in seven eyes around the macular, optic disc around the seven eyes, vascular bow and the nearby five eyes, the peripheral part of the two eyes. Type B ultrasound examination showed that the maximum diameter of tumor was 13.0mm × 11.6mm × 9.6mm. 3 eyes of visual acuity of 0.05 or less, 4 eyes of 0.06 to 0.2, and 14 eyes of 0.3 or more. The nuclide used for the applicator is 125I, setting the total amount of irradiation to 100 ~ 120Gy. The tumor is located in the macula, 14 cases of optic disc around the same time by the pupil thermotherapy. After treatment, the average observation time was 12 months and the longest was 3 years. To B-type ultrasound measurement of the tumor base and thickness (high) degree, if the thickness of more than 15% of the original thickness, or the edge of the base is greater than the original edge of 250mm as tumor enlargement. Results After treatment, the visual acuity decreased in 9 eyes, unchanged in 10 eyes and increased in 2 eyes. The tumor increased 6 eyes, unchanged 12 eyes, reduced 3 eyes. Complicated by vitreous hemorrhage in 2 eyes, retinal vascular occlusion in 1 eye, retinal branch vein occlusion in 1 eye, macular fold in 1 eye, retinal hemorrhage in 3 eyes, partial optic atrophy in 3 eyes, neovascular glaucoma in 1 eye Eyes, eyes removed 3 eyes. Conclusion The domestic applicator for choroidal melanoma for radiation therapy has the exact effect. But thicker on the tumor, the tumor is located in the macula or optic disc next to less effective.