中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2012年
4期
318-322
,共5页
高温,诱发%脉络膜肿瘤%血管瘤%治疗结果
高溫,誘髮%脈絡膜腫瘤%血管瘤%治療結果
고온,유발%맥락막종류%혈관류%치료결과
Hyperthermia,induced%Choroid neoplasms%Hemangioma%Treatment outcome
目的 观察经瞳孔温热疗法(TTT)治疗局限性脉络膜血管瘤的临床效果.方法 回顾性病例系列研究.收集114例(114只眼)经TTT治疗的单眼局限性脉络膜血管瘤患者的临床资料进行回顾性分析.其中男性80例,女性34例；年龄16 ～71岁,平均44岁.采用间接检眼镜、荧光素眼底血管造影、超声波检查眼底.采用波长810 nm的三用半导体激光治疗仪进行TTT治疗,治疗时光斑要覆盖整个瘤体,如瘤体较大可多个光斑组合；如肿物正位于或部分位于黄斑区,激光要避开黄斑和视乳头黄斑纤维束,旁黄斑区的激光能量要减小至病灶呈浅灰色反应斑；如肿物位于视乳头旁,要在视乳头旁留出200 μm的边缘不作治疗.结果 114例患者治疗后视力均有所改善,其中视力≥0.5者由治疗前的17只眼(14.9％)增至治疗后的27只眼(23.7％).治疗前除瘤体表面有视网膜脱离外,眼底下方也形成脱离者27例(23.7％)；瘤体位于黄斑区者67例(58.8％),位于视乳头周围者35例(30.7％),位于血管弓者12例(10.5％).治疗后渗液吸收并维持原视力者76例(66.7％),渗液吸收并视力增进者28例(24.6％).104例患者治疗有效,有效率91.2％；瘤体渗液不吸收或视力下降者为失败,共10例,失败率8.8％.32例患者治疗前肿瘤高度(3.90±1.15)mm,治疗后肿瘤高度(2.41±1.30)mm.治疗后随访1～7年者(平均22.8个月)27例,有效率仍达81.5％(22/27).术后发生并发症者9只眼(7.9％),其中黄斑少量出血2只眼,黄斑皱褶3只眼,黄斑水肿和囊样水肿2只眼,视网膜分支静脉阻塞1只眼,视野检查有弧形暗点1只眼.结论 TTT是治疗局限性脉络膜血管瘤的有效方法,治疗后的并发症少,操作简便、易行,值得在临床推广应用.
目的 觀察經瞳孔溫熱療法(TTT)治療跼限性脈絡膜血管瘤的臨床效果.方法 迴顧性病例繫列研究.收集114例(114隻眼)經TTT治療的單眼跼限性脈絡膜血管瘤患者的臨床資料進行迴顧性分析.其中男性80例,女性34例；年齡16 ～71歲,平均44歲.採用間接檢眼鏡、熒光素眼底血管造影、超聲波檢查眼底.採用波長810 nm的三用半導體激光治療儀進行TTT治療,治療時光斑要覆蓋整箇瘤體,如瘤體較大可多箇光斑組閤；如腫物正位于或部分位于黃斑區,激光要避開黃斑和視乳頭黃斑纖維束,徬黃斑區的激光能量要減小至病竈呈淺灰色反應斑；如腫物位于視乳頭徬,要在視乳頭徬留齣200 μm的邊緣不作治療.結果 114例患者治療後視力均有所改善,其中視力≥0.5者由治療前的17隻眼(14.9％)增至治療後的27隻眼(23.7％).治療前除瘤體錶麵有視網膜脫離外,眼底下方也形成脫離者27例(23.7％)；瘤體位于黃斑區者67例(58.8％),位于視乳頭週圍者35例(30.7％),位于血管弓者12例(10.5％).治療後滲液吸收併維持原視力者76例(66.7％),滲液吸收併視力增進者28例(24.6％).104例患者治療有效,有效率91.2％；瘤體滲液不吸收或視力下降者為失敗,共10例,失敗率8.8％.32例患者治療前腫瘤高度(3.90±1.15)mm,治療後腫瘤高度(2.41±1.30)mm.治療後隨訪1～7年者(平均22.8箇月)27例,有效率仍達81.5％(22/27).術後髮生併髮癥者9隻眼(7.9％),其中黃斑少量齣血2隻眼,黃斑皺褶3隻眼,黃斑水腫和囊樣水腫2隻眼,視網膜分支靜脈阻塞1隻眼,視野檢查有弧形暗點1隻眼.結論 TTT是治療跼限性脈絡膜血管瘤的有效方法,治療後的併髮癥少,操作簡便、易行,值得在臨床推廣應用.
목적 관찰경동공온열요법(TTT)치료국한성맥락막혈관류적림상효과.방법 회고성병례계렬연구.수집114례(114지안)경TTT치료적단안국한성맥락막혈관류환자적림상자료진행회고성분석.기중남성80례,녀성34례；년령16 ～71세,평균44세.채용간접검안경、형광소안저혈관조영、초성파검사안저.채용파장810 nm적삼용반도체격광치료의진행TTT치료,치료시광반요복개정개류체,여류체교대가다개광반조합；여종물정위우혹부분위우황반구,격광요피개황반화시유두황반섬유속,방황반구적격광능량요감소지병조정천회색반응반；여종물위우시유두방,요재시유두방류출200 μm적변연불작치료.결과 114례환자치료후시력균유소개선,기중시력≥0.5자유치료전적17지안(14.9％)증지치료후적27지안(23.7％).치료전제류체표면유시망막탈리외,안저하방야형성탈리자27례(23.7％)；류체위우황반구자67례(58.8％),위우시유두주위자35례(30.7％),위우혈관궁자12례(10.5％).치료후삼액흡수병유지원시력자76례(66.7％),삼액흡수병시력증진자28례(24.6％).104례환자치료유효,유효솔91.2％；류체삼액불흡수혹시력하강자위실패,공10례,실패솔8.8％.32례환자치료전종류고도(3.90±1.15)mm,치료후종류고도(2.41±1.30)mm.치료후수방1～7년자(평균22.8개월)27례,유효솔잉체81.5％(22/27).술후발생병발증자9지안(7.9％),기중황반소량출혈2지안,황반추습3지안,황반수종화낭양수종2지안,시망막분지정맥조새1지안,시야검사유호형암점1지안.결론 TTT시치료국한성맥락막혈관류적유효방법,치료후적병발증소,조작간편、역행,치득재림상추엄응용.
Objective To study the effects of transpupillary thermotherapy (TTT) on circumscribed choroidal hemangiomas (CCH). Methods It was a retrospective cases series study.One hundred and fourteen cases( 114 eyes ) in out-patient department were enrolled in the study with 80 male cases and 34 female cases.The age ranged from 16 to 71 yrs with an average at 44 years.Single eye was affected in all cases.Indirect ophthalmoscope,fundus fluorescein angiography ( FFA),ultrasound (B) were used for the examination.Treatment was delivered via slit lamp by using an 810 nm diode laser (Irises) with spots or composed spots (larger tumor) covering the whole tumor.If the tumor was located or partly located in the fovea,laser spot should be avoided in the fovea and papillo-macular bundle. The laser power should be lesser ( light gray color) in parafovea area.Routine laser spot ( gray-white color) was used in perifovea area.A width of 200 μm out of disk border should not be placed by laser spot in paradisk tumor cases.Results The visual acuity(VA)≥0.5 of pre-and post-treatment was 17 eyes( 14.9％ ) and 27 eyes (23.7％),respectively.Pre-treatment,the retinal detachment extended in the inferior part in 27 cases (23.7％) except on the tumor surface.The tumor was located at macular area in 67 cases (58.8％),around the disc in 35 cases (30.7％ ),at the temporal arcuate in 12 cases ( 10.5％ ).In our cases,VA maintenance with fluid absorption was noted in 76 cases (66.7％ ) after the treatment. VA improvement with fluid absorption in 28 case (24.6％ ).Both VA maintenance and improvement ( rate of efficiency) with fluid absorption were 91.2％.Fluid non-absorption or VA decline was regarded as unsuccessful in 10 cases (8.8％).The average thickness of 32 cases tumor pre- and post-treatment was (3.90 ± 1.15 )mm and ( 2.41 ± 1.30) mm.Twenty seven cases were followed up for ≥ 1 year (mean 22.8 months) with rate of efficiency at 81.5％. The complications (9 eyes,7.9％ ) contained minor macular hemorrhage in 2 eyes,macular pucker in 3 eyes,macular edema and cystoid macular edema in 2 eyes,retinal branch occlusion in 1 eye,and arcuate scotoma in 1 eye.Conclusions The treatment of TTT on CCH,whether the tumor located around-disc or in foveal area with exudative fluid could get successful in the majority of cases.TTT is one of the treatments worth doing owing to fewer complications,less expenses and easy-doing with definite and persistent effect.
