国产敷贴器治疗合并严重渗出性视网膜脱离的Sturge-Weber综合征的临床观察
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摘要
目的评价国产敷贴器治疗Sturge-Weber综合征弥漫性脉络膜血管瘤继发的渗出性视网膜脱离的临床疗效。设计回顾性病例系列。研究对象2009年6月至2018年6月北京同仁医院由临床和影像学诊断为弥漫性脉络膜血管瘤的SturgeWeber综合征患者15例,均存在渗出性视网膜脱离,均经国产敷贴器进行巩膜外敷贴放射治疗。方法记录患者治疗前后视力、眼压,彩色超声多普勒(CDI)测量瘤体大小(最大基底直径,最大高度),间接眼底镜,CDI及OCT下观察视网膜下液情况。采用SPSS 22.0对结果进行分析。主要指标视力、眼压、肿瘤大小,视网膜下液吸收情况及有无并发症发生。结果 15例患者平均随访48个月,末次随访与术前比较,视力提高(P<0.01)(术前0.01±0.02,末次随访0.05±0.11)。眼压无明显变化(P=0.132)(术前19.9±12.1 mmHg,末次随访15.6±2.4 mmHg)。术前瘤体最大基底直径(16.0±3.2)mm,术后末次随访(13.9±3.9)mm(P<0.01);术前瘤体最大高度(6.5±2.0)mm,术后末次随访(2.7±1.5) mm(P<0.01)。15例患者在末次随访时14例视网膜下液完全吸收,1例视网膜下液减少。结论国产敷贴器巩膜外敷贴放疗治疗Sturge-Weber综合征弥漫性脉络膜血管瘤继发的渗出性视网膜脱离是一种有效的方法。(眼科,2019, 28:125-128)
Objective To observe the safety and efficacy of domestic radioactive applicator for treatment of Sturge-Weber syndrome with exudative retinal detachment. Design Retrospective study. Participants 15 patients of Sturge-Weber syndrome with exudative retinal detachment that were treated with domestic radioactive applicator in Beijing Tongren Hospital from June 2009 to June 2018.Methods We recorded the data of visual acuity, intraocular pressure, size of the tumor(maximum base diameter, maximum height) measured by color Doppler imaging(CDI), changes in the subretinal fluid observed by indirect ophthalmoscope, CDI and OCT, and the data were retrospectively analyzed using SPSS 22.0. Main Outcome Measures Visual acuity, intraocular pressure, size of the tumor,changes in the subretinal fluid, occurrence rates of complications. Results Visual acuity significantly improved at latest follow-up(average follow-up was 48 months)(pre-operation 0.01 ±0.02, latest follow-up 0.05±0.11,P<0.01). Intraocular pressure remained similar(pre-operation 19.9±12.1 mmHg, latest follow-up 15.6±2.4 mmHg,P=0.132). Tumor regressed in all cases(maximum basal diameter,pre-operation 16.0±3.2 mm, latest follow-up 13.9±3.9 mm, P<0.01; maximum height, pre-operation 6.5±2.0 mm, latest follow-up 2.7±1.5 mm, P<0.01). No subretinal fluid was observed by indirect ophthalmoscope, CDI or OCT at the latest follow-up except for 1 case. Conclusion It seems to be a good choice to treat the Sturge-Weber syndrome with severe exudative retinal detachment by domestic radioactive applicator.(Ophthalmol CHN, 2019, 28: 125-128)
Objective To observe the safety and efficacy of domestic radioactive applicator for treatment of Sturge-Weber syndrome with exudative retinal detachment. Design Retrospective study. Participants 15 patients of Sturge-Weber syndrome with exudative retinal detachment that were treated with domestic radioactive applicator in Beijing Tongren Hospital from June 2009 to June 2018.Methods We recorded the data of visual acuity, intraocular pressure, size of the tumor(maximum base diameter, maximum height) measured by color Doppler imaging(CDI), changes in the subretinal fluid observed by indirect ophthalmoscope, CDI and OCT, and the data were retrospectively analyzed using SPSS 22.0. Main Outcome Measures Visual acuity, intraocular pressure, size of the tumor,changes in the subretinal fluid, occurrence rates of complications. Results Visual acuity significantly improved at latest follow-up(average follow-up was 48 months)(pre-operation 0.01 ±0.02, latest follow-up 0.05±0.11,P<0.01). Intraocular pressure remained similar(pre-operation 19.9±12.1 mmHg, latest follow-up 15.6±2.4 mmHg,P=0.132). Tumor regressed in all cases(maximum basal diameter,pre-operation 16.0±3.2 mm, latest follow-up 13.9±3.9 mm, P<0.01; maximum height, pre-operation 6.5±2.0 mm, latest follow-up 2.7±1.5 mm, P<0.01). No subretinal fluid was observed by indirect ophthalmoscope, CDI or OCT at the latest follow-up except for 1 case. Conclusion It seems to be a good choice to treat the Sturge-Weber syndrome with severe exudative retinal detachment by domestic radioactive applicator.(Ophthalmol CHN, 2019, 28: 125-128)
引文
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[3]陈子才,吴猛,刘晓琳.碘125眼巩膜敷贴器的计量学特性的研究.核技术,2001,24(5):393-397.
[4] Gottlieb JL, Murray TG, Gass JD. Low-dose external beam irradiation for bilateral diffuse choroidal hemangioma. Arch Ophthalmol,1998, 116(6):815-817.
[5] Madreperla SA, Hungerford JL, Plowman PN, et al. Choroidal hemangiomas:visual and anatomic results of treatment by photocoagulation or radiation therapy. Ophthalmology, 1997, 104(11):1773-1778.
[6] Frau E, Rumen F, Noel G, et al. Low-dose proton beam therapy for circumscribed choroidal hemangiomas. Arch Ophthalmol, 2004, 122(10):1471-1475.
[7] Ritland JS, Eide N, Tausj J. External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy. Acta Ophthalmol Scand, 2001, 79(2):184-186.
[8] Zografos L, Bercher L, Chamot L, et al. Cobalt-60 treatment of choroidal hemangiomas. Am J Ophthalmol, 1996, 121(2):190-199.
[9] Murthy R, Hanovaz SG, Naik M, et al. Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal haemangioma in Sturge-Weber syndrome. Indian J Ophthalmol, 2005, 53(4):274-275.
[10] Arepalli S, Shields CL, Kaliki S, et al. Diffuse choroidal hemangioma management with plaque radiotherapy in 5 cases. Ophthalmology, 2013, 120(11):2358-2359.
[11] Kubicka-Trzaska A, Karska-Basta I, Oleksy P, et al. Management of diffuse choroidal hemangioma in Sturge-Weber syndrome with Ruthenium-106plaque radiotherapy. Graefes Arch Clin Exp Ophthalmol, 2015, 253(11):2015-2019.
[12] Shields CL, Shields JA, Cater J, et al. Plaque radiotherapy for uveal melanoma:long-term visual outcome in 1106 consecutive patients. Arch Ophthalmol, 2000, 118(9):1219-1228.
[13] Quivey JM, Augsberger J, Snelling L, et al. 1251 plaque therapy for uveal melanoma:analysis of the impact of time and dose factors on local control. Cancer, 1996, 77(11):2356-2362.
[2]蔡善钰,卢凤才,王光璐,等.1251巩膜敷贴器的研制与临床观察.中国原子能科学研究院年报,2004, 27(1):141-142.
[3]陈子才,吴猛,刘晓琳.碘125眼巩膜敷贴器的计量学特性的研究.核技术,2001,24(5):393-397.
[4] Gottlieb JL, Murray TG, Gass JD. Low-dose external beam irradiation for bilateral diffuse choroidal hemangioma. Arch Ophthalmol,1998, 116(6):815-817.
[5] Madreperla SA, Hungerford JL, Plowman PN, et al. Choroidal hemangiomas:visual and anatomic results of treatment by photocoagulation or radiation therapy. Ophthalmology, 1997, 104(11):1773-1778.
[6] Frau E, Rumen F, Noel G, et al. Low-dose proton beam therapy for circumscribed choroidal hemangiomas. Arch Ophthalmol, 2004, 122(10):1471-1475.
[7] Ritland JS, Eide N, Tausj J. External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy. Acta Ophthalmol Scand, 2001, 79(2):184-186.
[8] Zografos L, Bercher L, Chamot L, et al. Cobalt-60 treatment of choroidal hemangiomas. Am J Ophthalmol, 1996, 121(2):190-199.
[9] Murthy R, Hanovaz SG, Naik M, et al. Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal haemangioma in Sturge-Weber syndrome. Indian J Ophthalmol, 2005, 53(4):274-275.
[10] Arepalli S, Shields CL, Kaliki S, et al. Diffuse choroidal hemangioma management with plaque radiotherapy in 5 cases. Ophthalmology, 2013, 120(11):2358-2359.
[11] Kubicka-Trzaska A, Karska-Basta I, Oleksy P, et al. Management of diffuse choroidal hemangioma in Sturge-Weber syndrome with Ruthenium-106plaque radiotherapy. Graefes Arch Clin Exp Ophthalmol, 2015, 253(11):2015-2019.
[12] Shields CL, Shields JA, Cater J, et al. Plaque radiotherapy for uveal melanoma:long-term visual outcome in 1106 consecutive patients. Arch Ophthalmol, 2000, 118(9):1219-1228.
[13] Quivey JM, Augsberger J, Snelling L, et al. 1251 plaque therapy for uveal melanoma:analysis of the impact of time and dose factors on local control. Cancer, 1996, 77(11):2356-2362.