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近年来由于手术技术的进展,虹膜睫状体的黑色素瘤一般可用虹膜切除术或虹膜睫状体切除术而治愈,不需摘除眼球。本文根据近200例的观察,讨论了诊断、治疗、预后及手术方法等问题。(1)诊断:患者年龄自6～80岁,平均45岁。病史中常在早年已有虹膜色素班存在。病损部位多发生于虹膜下半部,一般为色素性,呈中度或高度隆起,边缘不规则,其傍常有伴发的色素斑,可能是继发性肿瘤,也可能是无关的良性痣。肿瘤累及前房角时可引起继发性青光眼,故应用前房角镜、巩膜压陷合併Goldmann 氏接触镜观察睫状体病变范围。对一时不能确诊者可随访观察,用摄影加以记录,对比病变是否在扩大,以便确定性质。(2)治疗:①虹膜切除术:有明显恶性征象的虹膜病变,只要能用虹膜切除术彻底除去,即可施行本术。手术时注意勿使肿瘤细胞播散到眼内或切口处。角膜缘切口需大,以便在直接观察下作基底虹膜切除,切除范围应尽量向后,包括周边部虹膜极。②虹膜睫状体切除术:睫状体切除可引起出血,玻璃状体脱出、白内障、继发性青光眼、视网膜脱离等并发症。因此过去只要肿瘤扩大到不能作虹膜切除时,都作眼球摘除,不敢轻易施行睫状体切除术。近
In recent years due to the progress of surgical techniques, melanoma of the iris and ciliary body can generally be cured with iridectomy or iridotomy, without removal of the eyeball. This article based on the observation of nearly 200 cases, discusses the diagnosis, treatment, prognosis and surgical methods and other issues. (1) diagnosis: patients from 6 to 80 years old, with an average of 45 years old. Often in the early history of iris pigment classes exist. Lesions occur more often in the lower half of the iris, usually pigmented, was moderate or highly elevated, irregular edges, the next usually accompanied by pigmented spots may be secondary tumors may also be unrelated to the benign mole. Tumors involving the anterior chamber angle can cause secondary glaucoma, so the application of gonioscopy, scleral buckling combined with Goldmann’s contact lens observation of ciliary body lesions. Can not be diagnosed for a time follow-up observation, recorded by photography, the lesion is expanding, in order to determine the nature. (2) treatment: iridotomy: a clear signs of malignancy of the iris lesions, as long as the iris can be completely removed, you can perform this operation. Be careful not to spread tumor cells to the eye or incision at the time of surgery. Corneal incision needs to be large, so that under direct observation for iris resection, removal should be as far back as possible, including the peripheral iris pole. ② iris ciliary body resection: ciliary body resection can cause bleeding, vitreous prolapse, cataracts, secondary glaucoma, retinal detachment and other complications. So in the past as long as the tumor can not be extended to iris resection, are enucleated, not easy to implement ciliary body resection. near