孤立性脉络膜血管瘤的治疗

脉络膜血管瘤属于错构瘤性良性肿瘤 ,它有两种形态 ,一是边界清楚的孤立性脉络膜血管瘤 (circum scribed choroidalhemangioma) ,另一种则为弥漫性的肿瘤 ,它常伴有颅面血管瘤病 (Sturge- Weber综合征 )。孤立性脉络膜血管瘤都生长在赤道部以后 ,大多数肿瘤位于以中心凹为中心的 2 5°范围内。尽管未见肿瘤恶变及肿瘤极少增大 ,但常出现渗漏引起浆液性视网膜脱离而明显影响视力 [1 ] 。目前国际上都认同这样的观点 :对于没有症状或未发生浆液性视网膜脱离或黄斑囊样水肿的病例 ,应密切观察而不采用任何手段进行治疗。在 Shields等[1 ] 总…     

光动力疗法治疗孤立性脉络膜血管瘤

目的探讨光动力疗法（PDT）治疗孤立性脉络膜血管瘤的临床效果及安全性。方法孤立性脉络膜血管瘤患者5例,均经眼底检查、荧光素眼底血管造影（FFA）及彩色超声多普勒（CDI）检查确诊。其中4例伴有渗出性视网膜脱离和黄斑水肿。患者最佳矫正视力为0．02-0．8,CDI检查瘤体最大厚度为2．8-5．4mm,最大直径6．5-12．5mm。经PDT治疗后,患者随访时间为13-56周。结果所有患者均经1次PDT治疗后,渗出性视网膜脱离完全吸收,视力均稳定和提高。最终随访,患者最佳矫正视力为0．2-0．9。结论PDT治疗孤立性脉络膜血管瘤特别是位于黄斑部的脉络膜血管瘤的效果好且安全,可使瘤体萎缩并保存或提高患者视力。     

氩氯激光治疗孤立性脉络膜血管瘤

报告氩绿激光治疗８例伴有浆液性黄斑视网膜脱离的孤立性脉络膜血管瘤。激光光凝治疗后的血管瘤瘤体大部分或基本消失，脱离的视网膜复位，除黄斑中心凹部位血管瘤者外，患者视力明显提高。随访期内未见肿物复发。激光参数：光斑大小３００μｍ～４００μｍ，暴交时间０．２～１．０ｓ，输出功率０．３～０．５Ｗ。     

孤立性脉络膜血管瘤合并视网膜脱离的治疗

目的：探讨孤立性脉络膜血管瘤合并视网膜脱离的治疗方法。方法：７例脉络膜血管瘤合并视网膜脱离者,采用单纯氩激光治疗。９例脉络膜膜务管瘤合并视网膜明显脱离,视网膜下积液较多者,采用巩膜冷凝,排出视网膜下液联合氩激光治疗。结果：治疗后１３例的瘤体萎缩或缩小,渗出性视网膜脱离减少,视力幸或保持不变,单纯激光治疗组,有效率为７１．４３％。联合治疗组有效率为８８．８９％。结论：脉络膜血管瘤合并视网膜浅脱离者,     

光动力疗法治疗孤立性脉络膜血管瘤

孤立性脉络膜血管瘤(circumscribed choroidal hemangioma，CCH)是一种与全身疾病无关、发生于眼后极部的少见血管性肿瘤，临床上表现为眼赤道部以后，尤其是黄斑或视神经乳头旁的桔红色、光滑、圆或卵圆形病灶。尽管这些病变可以保持稳定，但它也可以进行性发展，当渗出性视网膜脱离、黄斑囊样水肿、视网膜下纤维化等出现影响到患视力     

孤立性脉络膜血管瘤一家系

先证者,男,５３ａ,左眼视物变形２年,视朦、眼前固定黑影３ｄ于１９９８年３月９日就诊。发病前饮酒较多,患重感冒、急性副鼻窦炎。全身检查：皮肤及脑血管均未见异常。眼科检查：视力右眼１－５,左眼０－４＋１－０ＤＳ１－２、左眼近视力０－４／３０ｃｍ,左眼眼压５－５／６＝１－９ｋＰａ,眼前节未见异常,眼底左眼视盘色红、边界不清、鼻侧与视神经盘相收稿　１９９９０６１９本文编辑　张知达作者单位　５１００７１　广州市,广州空军司令部门诊部连约２－５ＰＤ范围内视网膜呈桔红色、边界清、轻度隆起,视神经盘下方…     

经瞳孔温热疗法治疗孤立性脉络膜血管瘤

目的
观察经瞳孔温热疗法(transpupillary thermotherapy，TTT)治疗孤立性脉络膜血管瘤的疗效。
方法
回顾分析12例孤立性脉络膜血管瘤患者12只患眼采用TTT治疗的临床疗效。治疗使用Iris810 nm红外激光，能量220~1000 mW，光斑直径1.2、2.0、3.0 mm，照射时间1~2 min。观察治疗前后视力、视网膜下液、脉络膜血管瘤的厚度及渗漏的变化以及治疗的并发症等情况。随访6～16个月，平均随访10个月。
结果
12例脉络膜血管瘤患者中伴有周边视网膜脱离者8例，经TTT治疗后周边液体完全吸收6例，部分吸收2例。治疗后视力不变者7例、提高者3例、下降者2例。8例治疗前曾行B型超声检查者，治疗后B型超声检查7例瘤体厚度较治疗前降低，其厚度平均下降21.75%。10例治疗前行荧光素眼底血管造影检查者复查均可见瘤体的渗漏明显减轻。治疗的并发症有视网膜出血5例、视网膜皱褶1例。
结论
TTT是治疗脉络膜血管瘤的有效方法，特别适用于伴有明显视网膜脱离的患者。
(中华眼底病杂志, 2002, 18: 190-192)     

孤立型脉络膜血管瘤的激光治疗

目的探讨激光治疗孤立型脉络膜血管瘤的方法及疗效。方法用氩绿激光治疗6例（6只眼）孤立型脉络膜血管瘤,使用相适应的激光参数,分次治疗。结果经激光治疗后,视力提高5例,1例不变;瘤体周围渗液吸收。结论激光治疗孤立型脉络膜血管瘤是一种简单、安全、有效的方法。     

光动力学疗法治疗孤立性脉络膜血管瘤

孤立性脉络膜血管瘤(circumscribed choroidal hemangioma，CCH）是一种与全身疾病无关、发生于眼后极都的少见良性血管性肿瘤，临床上表现为眼赤道以后，尤其是黄斑或视神经乳头旁的桔红色、光滑、圆或卵圆形病灶。一般情况下，无症状者只需要定期随访，而一旦因浆液性视网膜脱离、黄斑囊样水     

倍频532nm激光光凝治疗孤立性脉络膜血管瘤的临床观察

目的 观察倍频532 nm激光光凝治疗孤立性脉络膜血管瘤的临床疗效.方法 对经眼底荧光血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green choroidal angiography,ICGA)检查确诊为孤立性脉络膜血管瘤的21例21眼患者行倍频532 nm激光治疗.治疗后2周、2个月、3个月、6个月、12个月复诊(最长5 a),包括眼压、眼底照相、FFA及ICGA检查;如发现仍有活动性渗漏者,再次行眼底激光治疗.结果 经激光治疗后患者视力提高15例,无变化4例,下降2例.眼底检查见视网膜平复,瘤体高度下降、呈青灰色,FFA和ICGA显示病灶无荧光渗漏,OCT示脉络膜毛细血管光带增厚、瘢痕形成.21例患者在激光治疗中期和后期未见全身及局部不良反应.结论 倍频532 nm激光光凝是治疗孤立性脉络膜血管瘤安全有效、简便易行的方法之一.     

两种方法治疗孤立性脉络膜血管瘤疗效对比

目的：对比观察在孤立性脉络膜血管瘤(circumscribed choroidal hemangioma,CCH)的治疗中,光动力学疗法(photodynamic therapy,PDT)与经瞳孔温热疗法(transpupillary thermotherapy, TTT )的临床疗效。

方法：选取CCH患者24例24眼,应用TTT治疗12例,PDT治疗12例。观察患眼治疗前后最佳矫正视力; 眼底彩色照片,检眼镜下观察瘤体变化; B超或彩色多普勒检查瘤体大小、高度变化; 光学相干断层扫描检查浆液性视网膜下积液的变化; 荧光素血管造影及吲哚菁绿血管造影判断瘤体渗漏情况及并发症等。

结果：所有患者经治疗后眼底检查均可见视网膜下浆液性渗出消失,彩色多普勒超声示瘤体萎缩,视网膜平伏,血流呈阴性,荧光素血管造影联合吲哚菁绿血管造影可见瘤体血管荧光渗漏减轻,光学相干断层扫描示黄斑及瘤体浆液性视网膜脱离完全平伏,瘤体平复。TTT治疗患者12例12眼术后视力提高、稳定、下降比例,各占33.3%; 眼底观察可见瘤体萎缩瘢痕,机化,大量色素增生或色素缺失,部分血管闭塞。PDT治疗患者12例12眼,视力提高者66.7%,视力稳定者33.3%,无视力下降; 眼底观察可见瘤体萎缩呈白色,轻度色素紊乱,视网膜及脉络膜正常血管未见损害。

结论：TTT与PDT治疗CCH,均能使瘤体萎缩并促进渗出吸收,但PDT对眼底正常组织损伤明显小于TTT,具有更高的安全性。     

孤立型脉络膜血管瘤的超声诊断

目的 探讨孤立型脉络膜血管瘤的超声诊断价值。方法 使用标准化A超联合B超诊断6例脉络膜血管瘤。结果 脉络膜血管瘤B超显示实性占位病变，回声与正常脉络膜组织回声一致；A超表现为病变内高反射波。结论 超声检查是诊断脉络膜血管瘤有价值的辅助手段。     

Photodynamic therapy of circumscribed choroidal hemangioma

PURPOSE: To evaluate the safety and effectiveness of photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangiomas (CCH) of the posterior pole. DESIGN: Prospective, consecutive, noncomparative case series. PARTICIPANTS: Ten eyes of 10 patients (six males and four females; age range, 38-64 years) reporting visual impairment caused by intraocular CCH. Follow-up was 7 to 16 months. METHODS: Photodynamic therapy was applied by Zeiss laser (Visulas 6905, Carl Zeiss-Meditech AG, Jeud Germany) emitting a light at 689 nm for photosensitization and by using verteporfin (Visudyne; Novartis Ophthalmics AG, Basel, Switzerland) at a dose of 6 mg/m(2) body surface administered intravenously before treatment. The diameter of the treatment spot was calculated on early frames of pretreatment indocyanine green angiography; the maximum treatment spot diameter was 6000 micro m using a Mainster wide-field lens (Ocular Instruments Inc., Bellevue, WA USA). In the case of peripapillary CCH, the laser spot was applied at a distance of 200 micro m from the optic disc edge. A laser beam was applied to the retina 15 minutes after the start of the infusion. Two different treatment procedures were used according to the height of the lesion. A radiant exposure of 100 J/cm(2) with an exposure time of 186 seconds was applied to lesions larger than 2 mm. For lesions smaller than 2 mm, a radiant exposure of 75 J/cm(2) with an exposure time of 125 seconds was used. MAIN OUTCOME MEASURES: Visual outcomes, pretreatment findings, and final findings were evaluated using biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA), and ultrasound. RESULTS: After a follow-up of 7 to 16 months, FA and ICGA verified the nonperfusion of the vascular channels of the tumor in the treated areas. No retinal pigment epithelium (RPE) changes were observed in the patients who had undergone two PDT treatments, whereas minimal alterations were detected in two of the four patients who had undergone three treatment sessions. Angiographic cystoid macular edema and exudative macular detachment had completely regressed in all cases. Minimal intraretinal edema was observed on the FA frames in two cases. Ultrasound examination found no measurable tumor height in six (60%) cases and a marked reduction in the remaining four cases, even after one treatment (post treatment tumor height range, 0.86-1.82 mm). An improvement in visual acuity (one to six lines on the Early Treatment for Diabetic Retinopathy Study chart) was observed in all the cases. In four cases, the visual acuity returned to 20/20, of which three were extrafoveal and one was subfoveal with visual impairment caused by secondary exudative macular detachment without significant RPE alterations. Also in longstanding subfoveal cases, a marked visual acuity improvement was detected resulting from the disappearance of subretinal or intraretinal fluid, even if functional results were limited by pre-existing RPE alterations. In all cases no damage to retinal vessels was observed. CONCLUSIONS: Photodynamic therapy is a minimally invasive but effective method of treatment for CCH and may be considered as a treatment of choice, especially in patients with foveal location of the tumor. Because of its safety and repeatability, this technique can be used to treat frequent recurrences of the tumor.     

Photodynamic therapy of circumscribed choroidal hemangioma

PURPOSE: To evaluate efficacy of photodynamic therapy (PDT) with verteporfin in treatment of posterior pole symptomatic circumscribed choroidal hemangiomas. MATERIAL AND METHODS: Four patients (3 men and 1 woman), 15-55 years old (mean age: 29 years) with circumscribed choroidal hemangiomas of the posterior pole, were examined. The hemangiomas localization were subfoveal in one patient, extrafoveal in 2 cases, and juxtapapillar in one case. The diagnosis of choroidal hemangioma was established on the base of clinical examination, A and B--scan ultrasound imaging, Doppler ultrasonography, fluorescein and indocyanine angiography results. Tumour thickness before treatment ranged from 2.3-3.6 mm (mean thickness: 2.8 mm). One course of PDT with verteporfin was performed in 3 cases, while in one patient PDT was performed four times. RESULTS: In a follow-up period which range from 3 to 14 months (mean 5.7 months) all cases demonstrated clinical features of lesion regression with a reduction of thickness on ultrasonography and choroidal vasculature on angiograms. Visual acuity was improved in 3 patients (from 1 to 4 lines on Snellen charts), or remained stable in 1 case. CONCLUSIONS: Our preliminary results indicate that PDT with verteporfin is a safe and effective method of treatment for circumscribed choroidal hemangiomas, especially in patients with posterior pole location of the tumour.     

经瞳孔温热疗法治疗限局性脉络膜血管瘤

目的探讨经瞳孔温热疗法治疗限局性脉络膜血管瘤的临床效果。方法经眼底检查和荧光素眼底血管造影确诊为限局性脉络膜血管瘤的患者10例（10只眼）,年龄16—48岁,平均34岁。采用经瞳孔温热疗法,以810红外激光对病变区连续照射1～5个光斑,光斑直径3．0mm,将肿物完全覆盖。激光功率为800～1200mw,照射时间60s,或延长10～20s。术后1—3个月随诊。视病情需要可重复治疗1～3次。患者随访期3～36个月,平均14个月。其中4例患者为首次治疗;6例曾接受绿激光（氪和氩）光凝治疗。结果末诊时,有1例脉络膜血管瘤患者病变正位于黄斑中心区,视网膜下尚有积液,眼底有透红光区,需继续治疗,余9例视网膜下积液完全消退,荧光素眼底血管造影和吲哚氰绿脉络膜血管造影检查,肿瘤区无强荧光出现,视力增进;经过半年至2年随诊,患者病情稳定。未发生术后并发症或后遗症。结论经瞳孔温热疗法治疗限局性脉络膜血管瘤的临床效果肯定。无论单独作为首选治疗或用于补充以前光凝治疗的不足,均可获得良好效果。（中华眼科杂志,2005,41：882-886）     

Oral propranolol for circumscribed choroidal hemangioma

Introduction

Several therapeutic approaches have been developed to treat choroidal hemangioma. However, all these therapies are associated with a potential risk of damaging the overlying retina.

Case Report

We report a case of circumscribed choroidal hemangioma (CCH) in a 59-year-old man refractory to laser treatment. Visual acuity was 20/200 and a serous macular detachment was present. The CCH was treated with oral propanolol, whereupon visual acuity improved to 20/20 and the macular detachment resolved without systemic or local adverse effects.

Discussion

Propanolol is a β-blocker commonly used in cardiology that may induce endothelium vasoconstriction and inhibit endothelial proliferation. It has been shown to be effective in infantile facial hemangiomas, and proved safe and effective for the CCH in our patient. Further studies are needed to confirm our observation.Key Words: Circumscribed choroidal hemangioma, Propanolol, β-Blocker