经瞳孔温热疗法治疗三种眼底良性肿瘤

目的 观察经瞳孔温热疗法（TTT）治疗三种眼内良性肿瘤的疗效。 方法 通过最佳矫正视力、眼压、视野、眼前节和眼底检查以及彩色眼底照相、荧光素钠和吲哚青绿血管造影、B型超声、光相干断层扫描（OCT）、CT等检查确诊的眼内良性肿瘤患者17例20只眼。男12例，女5例，右眼8只，左眼12只。其中，视盘血管瘤3例3只眼，平均视力为0.17，2只眼曾行手术放液;脉络膜血管瘤9例9只眼，平均视力为0.39，其中4例为首诊病例，5只眼曾做过激光光凝治疗，肿瘤未全平复，尚有浆液性视网膜脱离;脉络膜骨瘤5例8只眼，平均视力为0.20，其中3只眼合并黄斑出血。TTT用810 nm半导体红外激光，光斑3.0 mm，按肿物大小连接照射1～5个光斑。功率360～1200 mW，时间60～80 s。1～3次为1疗程，2次治疗之间间隔时间1个月;需要时再作1疗程治疗。治疗后定期随访观察，时间为3～36个月，平均随访时间14.5个月。 结果 随访结束时平均视力，视盘血管瘤患者为0.27，脉络膜血管瘤患者为0.46，脉络膜骨瘤患者为0.31。视盘血管瘤3只眼瘤体的红色部位缩小，表面纡曲扩张的血管变平直，视盘周围出现脉络膜萎缩弧，视网膜下浆液性渗出消失。脉络膜血管瘤9只眼瘤体透红光区消失，视网膜下积液消退，治疗区色素增生。脉络膜骨瘤8只眼中视网膜下积液吸收，肿瘤颜色由黄红变为黄白，并出现色素和薄的瘢痕，合并黄斑出血者出血消失。所有患眼治疗后未出现严重并发征。 结论 TTT治疗视盘血管瘤、脉络膜血管瘤和脉络膜骨瘤，无论首次接受治疗或补充以前治疗均获一定效果。 (中华眼底病杂志, 2006, 22:181-184)     

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(transpupillarythermotherapy,TTT)治疗脉络膜血管瘤的疗效。方法回顾分析12例12眼脉络膜血管瘤患者行TTT治疗的临床疗效,根据瘤体的大小选择不同大小的光斑(1.0～3.0mm)和能量(300～1000mW),照射时间1分钟。观察视力、视网膜下液、瘤体、脉络膜血管渗漏变化和并发症的发生情况。随访12～14月,平均13.6月。结果12例脉络膜血管瘤患者中伴局限性或广泛性渗出性视网膜脱离11例。经TTT治疗后,视网膜下液完全吸收,12例瘤体萎缩,FFA显示瘤体渗漏明显减轻,未见明显并发症。视力提高者9例,不变者2例,下降者1例。结论TTT是治疗脉络膜血管瘤的有效方法,尤其适用于伴明显视网膜脱离的患者。     

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)     

光动力疗法治疗孤立型脉络膜血管瘤的疗效观察

目的观察单次光动力疗法治疗脉络血管瘤的有效性和安全性。方法回顾分析10例孤立型脉络膜血瘤患者11只眼的临床资料。10例患者中男6例，女4例，平均年龄402岁；1例双眼发病，6只左眼，5只右眼；均采用单次光动力疗法治疗，随访1～14个月,平均随访时间6.2个月。结果11只眼治疗后，全部瘤体都有不同程度萎缩，视网膜下液吸收，其中视力提高者8只眼，视力稳定者3只眼 。结论光动力疗法是治疗孤立型脉络膜血管瘤的有效治疗方法。 （中华眼底病杂志，2008，24：111-113）     

相干光断层扫描在眼内肿瘤诊断中的临床应用

目的 研究相干光断层扫描（OCT）在多种眼内肿瘤诊断中的临床价值.设计回顾性系列病例.研究对象 49例（52眼）未行治疗的多种眼内肿瘤的OCT图像.方法 收集2006～2009年在北京同仁医院进行OCT检查（Zeiss StratusOCT Model 3000）的49例（52眼）未行治疗的眼内肿瘤的临床资料,对各种肿瘤的OCT图像进行分析.肿瘤诊断根据患者的典型症状、病史、跟底镜下表现并综合眼底血管造影、眼彩色多普勒超声检查、眼眶CT和MRI结果.其中14例脉络膜黑色素瘤及3例睫状体肿瘤在局部切除后病理检查确诊 2例脉络膜转移癌有明确原发恶性肿瘤.主要指标OCT图像表现.结果 42眼脉络膜肿瘤（脉络膜黑色素瘤27眼、脉络膜转移癌2眼、脉络膜血管瘤5眼、脉络膜骨瘤8眼）的OCT表现为瘤体处视网膜及色素上皮层（RPE）光带隆起,伴不同程度的反射强度改变及层次紊乱,光带后瘤体为暗区 瘤体局部（27眼）和黄斑部（27眼）可见视网膜神经上皮层脱离.视网膜内（下）高反射点仅见于脉络膜黑色素瘤,脉络膜骨瘤的RPE光带反射显著增强且极不规则.7眼视网膜肿瘤（视网膜星形细胞错构瘤2眼、视网膜血管瘤5眼）的OCT表现为视网膜光带隆起,反射强度不均匀,RPE光带不能显示 3眼可见黄斑区视网膜神经上皮层水肿、脱离.其中视网膜星形细胞错构瘤隆起的视网膜光带可见特殊的虫蚀样外观.3眼睫状体肿瘤（黑色素瘤1眼、无色素上皮腺瘤2眼）OCT未能扫描到瘤体,2眼黄斑部OCT正常,1眼黄斑部视网膜水肿伴神经上皮层浅脱离.结论 OCT可显示肿瘤继发性的瘤体局部和邻近的视网膜及黄斑部改变,在一定程度上提示肿瘤的性质帮助诊断.     

孤立性脉络膜血管瘤光凝治疗疗效观察

目的 观察探讨脉络血管瘤的临床光凝治疗效果。方法 回顾分析27例27眼脉络膜血管瘤的临床资料。27例中男16例，女11例，平均年龄45．4岁，右眼12例，左眼15例，均为单眼发病，均属于脉络膜血管瘤病(chomidal Hemangioma，CH)，按照瘤体大小、局限性视网膜脱离、广泛性视网膜脱离，将本病分为三期。治疗方法均采用激光治疗，全部病历随访12个月以上，平均随访时问35．5个月。结果 其中25只眼治疗后，全部血管瘤得以控制，其中视力提高者11眼，不变者8眼，下降者7眼，1眼病情进展至无光感。结论 激光是治疗孤立性脉络膜血管瘤的有效治疗方法。     

经瞳孔温热疗法治疗视网膜大动脉瘤的疗效观察

目的观察经瞳孔温热疗法(TTT)治疗视网膜大动脉瘤的疗效。方法采用经瞳孔温热疗法对视网膜大动脉瘤24例(24只眼)进行治疗。根据荧光素眼底血管造影(FFA)显示的瘤体大小及荧光渗漏情况,采用810 nm激光照射,激光功率、光斑直径和曝光时间为500～1000 mW、800～1200μm和60 s。结果经1年随访,视力增进2行以上者9只眼。视力提高1行者8例,视力不变者5例,视力下降1～2行者2例。3个月后FFA显示:24例瘤体完全萎缩,无荧光素渗漏。结论 TTT治疗视网膜大动脉瘤安全、有效。     

脉络膜骨瘤的临床表现和治疗探讨

目的探讨脉络膜骨瘤的临床表现和治疗效果。方法脉络膜骨瘤患者12例（18只眼）,其中男性5例,女性7例;8只右眼,10只左眼。患者均行常规眼部检查：包括最佳矫正视力、眼压、视野、眼前节和眼底检查。专项检查：包括彩色眼底照相、荧光素眼底血管造影（FFA）和（或）吲哚氰绿眼底血管造影（ICGA）、B超、CT、视野和眼电生理检查。对患者进行如下治疗：（1）服用抗感染和维生素类药物,临床随诊观察。（2）采用多波长氪激光光凝治疗。（3）采用经瞳孔温热疗法（TTT）,治疗次数一般为1—5次,两次治疗间隔时间为1个月。全部患者均预约定期随诊,随诊期为1至26年,中位数为2．5年。结果（1）服用药物并定期随访者共6例（8只眼）。随访过程中,发现脉络膜骨瘤增大缓慢,生长边缘呈伪足状前移,瘤体增大。随诊时间最长者1例,26年后复诊肿瘤已自行消退。（2）激光光凝治疗2例（4只眼）,术后脉络膜骨瘤边缘出现光凝色素斑,其中2只眼在近视乳头和黄斑处仍有少许浆液性渗出和视网膜浅脱离,1只眼有黄斑出血,FFA检查显示有脉络膜新生血管（CNV）形成,2例患者经TTT补充治疗后病情好转。（3）单用TTT治疗4例（6只眼）,其中1例（1只眼）有黄斑出血,FFA和ICGA检查显示有CNV渗漏,经TTT治疗后好转;1例（2只眼）,经TTT治疗后肿瘤处浆液渗出减少,有青灰色素和薄的机化瘢痕增生。结论脉络膜骨瘤在自然病程中缓慢生长,有伪足样边缘。激光光凝有一定效果。TTT可单独用于治疗或辅助激光光凝之不足,特别适用于合并有黄斑中心凹下CNV的患眼。     

光动力疗法与经瞳孔温热疗法治疗孤立型脉络膜血管瘤的疗效观察

目的 观察经瞳孔温热疗法(TTT)和光动力疗法(PDT)治疗孤立型脉络膜血管瘤(CCH)的疗效.方法 回顾性分析经眼底检查、荧光素眼底血管造影(FFA)、吲噪青绿血管造影(ICGA)、光相干断层扫描(OCT)、眼部B型超声检查确诊为CCH的患者32例33只眼的临床资料.所选病例治疗前最佳矫正视力为指数/眼前～0.2,瘤体大小2～10个视盘直径(DD),均有浆液性视网膜脱离.其中21例22只眼CCH位于除乳斑柬及黄斑拱环内区域外的后极部采用经瞳孔温热疗法(TTT)治疗.使用Iris 810 nm半导体红外激光,能量700～1200 mw,时间60 S,光斑1～3个不等;11例11只眼CCH位于乳斑束及黄斑拱环以内区域的PDT治疗.经静脉注射维速达尔15 min后采用689 nm波长半导体激光对病灶进行照射83～123 s.随访时间12～48个月,平均随访时间为25.6个月.治疗后复查视力、间接检眼镜、彩色眼底照像、FFA、ICGA、OCT和B型超声波检查,观察其疗效.结果 TTT治疗22只眼中,15只眼视力提高,7只眼视力稳定,眼底检查见视网膜平复,瘤体呈灰白色机化瘢痕,造影显示病灶无荧光渗漏,晚期机化瘢痕处呈荧光染色.OCT检查显示22只眼视网膜神经上皮脱离消失,视网膜下积液完全吸收,其瘤体部脉络膜光带反射增强,瘢痕形成;B型超声检查显示22只眼无视网膜脱离,瘤体萎缩.PDT治疗11只跟中9只眼视力提高,2只眼视力稳定,眼底检查见瘤体萎缩,色素沉着,造影显示荧光渗漏消失;OCT显示视网膜下液完全吸收,B型超声检查11只眼瘤体萎缩.结论 TTT与PDT治疗CCH有效但适用部位有所不同.两种方法均可使瘤体萎缩,稳定或提高患者的视力.     

弥漫性脉络膜血管瘤的诊断与治疗

目的 探讨弥漫性脉络膜血管瘤的诊断、治疗及疗效.方法 回顾分析4例4只眼弥漫性脉络膜血管瘤的诊疗过程与预后.4例患者中男性2例,女性2例.年龄6-19岁,均因弥漫性脉络膜血管瘤而继发渗出性视网膜脱离,其中1例伴青光眼.4例患者中3例伴有同侧颜面部血管痣;3例伴同侧软脑膜血管瘤.一例行药物保守治疗,一例先行3次经瞳孔温热疗法(Transpupillary thermotherapy,TTT)治疗弥漫性脉络膜血管瘤,因无效再行光动力治疗(Photodynamictherapy,PDT);另两例则直接行PDT治疗,治疗次数2-3次.治疗前后观察视力、眼压、眼底及B超等变化.结果 保守治疗者1个月后因眼压持续升高且全视网膜脱离而失明.行PDT治疗者治疗后视网膜下液均完伞吸收,瘤体厚度有不同程度的降低,眼压稳定,视力维持.TTT治疗无效者再行PDT治疗亦能获得相同的效果.结论 虽然PDT治疗不能使肿瘤完全萎缩或消失,但可使浆液性脱离的视网膜复位.维持视力,所以可作为弥漫性脉络膜血管瘤的治疗手段之一.     

Transpupillary thermotherapy (TTT) in circumscribed choroidal hemangioma

BACKGROUND: Choroidal hemangioma presents a therapeutic dilemma. Although it is a benign tumor, it may lead to massive exudation of subretinal fluid and a loss of visual function. Argon laser photo-coagulation in a grid pattern may be followed by initial absorption of subretinal fluid, but recurrence is common. Trans-scleral cryotherapy is difficult to apply at the posterior pole of the eye. External beam irradiation may bear a risk of maculopathy and papillopathy. Brachytherapy does not allow placement of radiation to the hemangioma sparing other retinal or choroidal structures. We sought to determine whether transpupillary thermotherapy (TTT) is suitable for treatment of choroidal hemangioma at the posterior pole. METHODS: We present ten patients with choroidal hemangioma. All of these received TTT. The mean follow-up period was 13.3 months (3-21 months). TTT was delivered via a slitlamp microscope with a diode laser at 810 nm. RESULTS: After TTT, reduction in tumor prominence was observed in eight patients at 3 months after treatment by A scan sonography. Visual acuity improved by more than three lines in four patients, and remained unchanged in all other patients. Two patients were retreated to achieve complete absorption of fluid. Serous retinal detachment persisted in three patients because the hemangioma could not be treated completely because of proximity to the fovea. CONCLUSION: Our preliminary results suggest that TTT may be used effectively to treat some choroidal hemangiomas in the first instance and prevent fluid leakage provided the lesion does not involve the fovea. However, long-term follow-up and more cases are needed to evaluate the long-term visual outcome and potential risks.     

Vitrectomy for circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy

We report successful surgical management of a circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy (TTT). A 33-year-old man with symptomatic serous macular detachment in the left eye (Snellen acuity: 20/200) secondary to a paramacular choroidal hemangioma was treated with TTT. The nonresponsive detachment was subsequently managed by vitrectomy, endophotocoagulation and silicon-oil tamponade. It resulted in complete resolution of the tumor and the detachment. Silicon oil was removed at four months. Visual acuity improved to 20/80 by the last follow-up visit at 10 months without any recurrence.     

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）     

Retinal break and rhegmatogenous retinal detachment after transpupillary thermotherapy as primary or adjunct treatment of choroidal melanoma

OBJECTIVE: To report the development of retinal break or rhegmatogenous retinal detachment (RRD) after transpupillary thermotherapy (TTT) as primary or adjunct treatment of choroidal melanoma. METHODS: In this noncomparative, interventional case series, the authors reviewed medical records of 13 patients who developed retinal break or RRD following TTT. The main outcome measures were clinical features and outcome of treatment of retinal break or RRD following TTT. RESULTS: Of 1574 patients managed on the Oncology Service at Wills Eye Institute with TTT as primary or adjunct treatment of choroidal melanoma, 13 (1%) developed retinal break with or without RRD. The mean patient age at diagnosis of choroidal melanoma was 56 years. Treatment for choroidal melanoma included combined plaque radiotherapy and TTT in 10 patients and TTT alone in 3 patients. The median number of TTT sessions before development of retinal break or RRD was 2. Retinal break or RRD developed at a median of 3 months following the last TTT. All the retinal breaks were located in the TTT-treated area. Retinal breaks were atrophic in 11 eyes and horseshoe shaped in 2 cases. The extent of retinal detachment was none in 1 eye, 1 quadrant or less in 5 eyes, 2 or 3 quadrants in 4 eyes, and 4 quadrants in 3 eyes. Seven patients underwent vitrectomy, one received cryotherapy and laser photocoagulation, and five were observed without treatment. In all eight patients who received treatment for RRD, the retina was attached after a mean follow-up period of 54 months with no intraocular or local extraocular tumor dissemination. CONCLUSIONS: Development of retinal break or RRD is a rare complication of TTT for treatment of choroidal melanoma. The majority of these cases develop within 6 months of TTT and most are caused by atrophic retinal holes in the TTT-treated area.     

近视盘视网膜毛细血管瘤的临床特征分析

目的观察近视盘视网膜毛细血管瘤的临床特征方法回顾分析18例近视盘毛细血管瘤19只眼的临床资料、16只眼的荧光素眼底血管造影（FFA）以及7只眼的随访观察资料。结果18例患者中，男女比为1：2，平均年龄为28.9岁。3例4只眼合并周边视网膜瘤。19只眼血管瘤中心均位于视盘的边缘以外，以颞下象限为最多（7/19），血管瘤大小为1.0-2.5个视盘直径（DD），颜色以红色为主（12/19）。16只眼FFA检查显示13只眼造影晚期有“排空”现象。长期随访的7只眼（其中5只眼经过激光光凝治疗）视力均下降。初诊时无渗出性视网膜脱离的6只眼（其中4只眼、未经过治疗的只眼）在平均随访的54.4个月后均未发生视网膜脱离。结论近视盘视网膜毛细血管瘤多呈类似椭圆形、橙黄色或红色包块。瘤体的中心位于视盘的边缘外。患者多在青壮年期出现视力下降的症状，有症状者瘤体周围均有不同程度的渗出、视网膜水肿。视力下降较缓慢，治疗效果差。FFA检查有助于本病的诊断和鉴别诊断。（中华眼底病杂志，2004，20：1-4）     

Tumor regression and visual outcome after transpupillary thermotherapy (TTT) for malignant choroidal melanoma

BACKGROUND: The aim of this study was to evaluate the course of tumor regression and visual impairment in choroidal melanomas treated by transpupillary thermotherapy (TTT) alone. PATIENTS AND METHODS: In a prospective, non-randomized analysis 26 patients suffering from primary choroidal melanoma (posterior to the equator with base < or = 12 and thickness < or = 4.5 mm) were treated with the TTT standard protocol and followed for 33 - 45 months. Fluorescein and ICG angiographies were performed initially and after tumor regression clinically. RESULTS: 22 tumors were significantly flattened after 1 - 3 TTT sessions. 4 tumors required additional therapy with ruthenium plaque. Visual acuity remained unchanged or improved in 11 eyes. In all eyes fluorescein and indocyanine green angiography revealed a sharp demarcation of the heat-treated area. Except for macular edema and gliosis in 6 eyes no vascular or retinal tissue damage was noticed outside the treatment zone. In the periphery of the treatment zone all eyes showed residual choriocapillaries remaining perfused. During follow-up 2 eyes revealed tumor regrowth at the posterior margin of the scar, which was successfully managed by TTT or a ruthenium plaque. 2 eyes developed late choroidal neovascularizations (CNV) in the heat-treated area. One patient died of liver metastases. CONCLUSIONS: Fluorescein and indocyanine green angiographic findings after TTT for small choroidal melanomas suggest that the tissue damage in the choroidal layer is less effective, which perhaps can lead to a higher rate of tumor regrowth. Development of choroidal neovascularization may be a sign of late heat-induced side effects of TTT.     

Ocular features of choroidal osteoma in a patient with 23-year period observation—A case report

A 59-year-old Chinese female had been diagnosed with choroidal osteoma of the right eye when she was 36. At that time, the best corrected visual acuity was 6/6 but this decreased to 6/12 due to the rapid growth of choroidal osteoma within 10 months. She returned to our clinic 23 years later due to gradual decreased vision (2/60). Ocular examination disclosed spontaneous decalcification of the tumor leaving an area of depigmentation and atrophy of choriocapillaris in the previous osteoma. Time-domain optical coherence tomography showed marked thinning and absence of the inner segment/outer segment photoreceptor junction with irregular elevated retinal pigment epithelium. To sum up, choroidal osteoma is a benign intraocular tumor that can cause visual acuity loss due to retinal pigment epithelium atrophy and photoreceptor degeneration over the years.     

Transpupillary Thermotherapy in the Treatment of Choroidal Metastasis from Breast Carcinoma

BACKGROUND: Most patients who develop metastatic carcinoma to the choroid are managed by local radiation or chemotherapy. Since transpupillary thermotherapy (TTT) is currently gaining attention as an optional treatment for choroidal melanomas and hemangiomas, we sought to determine whether TTT is suitable for treatment of solitary choroidal metastasis at the posterior pole. METHOD: We report on a patient with decreased vision due to a serous macular detachment in a eye with a solitary choroidal metastasis from breast carcinoma, who was managed by TTT. RESULTS: After two months of follow up, total re-absorption of the serous macular detachment was achieved and the patient recovered full visual acuity in the treated eye. The choroidal mass became atrophic and hyperpigmentation of the retinal pigment epithelium and retinal folds in the macular region were observed. After six months of TTT, the ocular picture remained unchanged. CONCLUSION: TTT can be considered an acceptable therapeutic option for solitary choroidal metastasis associated with serous retinal detachment.