微创玻璃体切割术联合局部完整剥除治疗脉络膜黑色素瘤

目的：观察微创玻璃体切割术联合局部完整剥除治疗脉络膜黑色素瘤的疗效。方法：回顾性系列病例研究。选取2014年1月至2017年12月在山东中医药大学附属眼科医院确诊为脉络膜黑色素瘤，并行微创玻璃体切割联合肿瘤局部剥除术的患者13例（13眼），排除全身转移和局部巩膜、视神经侵犯。肿瘤基底径（11.2±4.2）mm，高径（9.2±1.1）mm。肿瘤位于赤道及赤道后11例，手术方式为微创玻璃体切割联合眼内完整剥除肿瘤后自睫状体扁平部切口娩出；肿瘤位于赤道前2例，累及1/4睫状体，手术方式为微创玻璃体切割联合巩膜瓣下完整剥离肿瘤后取出。13例患者初次手术眼内均填充硅油并保留晶状体。术后随访6～54个月，每隔6个月行全身检查排除全身转移。结果：13例患者病理诊断均确诊为脉络膜黑色素瘤。随访期间无肿瘤局部复发、全身及眼部转移。术后患者最佳矫正视力（LogMAR）0.3～0.9，其中0.8～0.9者5例，0.3～0.8者8例。术后3个月13例患者均行硅油取出术。其中8例因并发性白内障联合白内障超声乳化术，5例植入人工晶状体，3例（23.1%）发生肿瘤切除部位的增殖性视网膜病变，行手术视网膜复位后再次硅油充填，未植入人工晶状体。结论：根据肿瘤大小、位置采取眼内或眼外局部完整剥除联合微创玻璃体切割术是治疗脉络膜黑色素瘤的有效方法，既保留了眼球，又拥有一定的视力。

Minimally Invasive Vitrectomy Combined with Local Intact Exfoliation for the Treatment of Choroidal Melanoma

Objective: To observe the effect of minimally invasive vitrectomy combined with local complete exfoliation in the treatment of choroidal melanoma. Methods: By retrospective analysis, 13 choroidal melanoma patients (13 eyes) were selected in the Affiliated Eye Hospital of Shandong University of raditional Chinese Medicine from January 2014 to December 2017. The patients were treated with minimally invasive vitrectomy combined with complete local exfoliation. Systemic metastasis and local scleral and optic nerve invasion were excluded. Mean basal diameter of the tumor was 11.2±4.2 mm. Average height diameter was 9.2±1.1 mm. Tumors were located at the posterior pole and at the equator in 11 cases. Minimally invasive vitrectomy was adopted in combination with intraventricular resection, then the tumors were removed completely. Two of the tumors were large enough to reach the anterior equatorial ciliary body. Minimally invasive vitrectomy was adopted in combination with tumor dissection from the scleral flap. The patients underwent primary surgery with silicone oil and lens retention. Patients were followed up from postoperative 6 months to 54 months. Local and systemic exams were done every 6 months. Results: All 13 patients were diagnosed with choroidal melanoma by pathological diagnosis. During the follow-up, there was no recurrence, or systemic or ocular metastasis. Postoperative best corrected visual acuity (BCVA) was 0.3-0.9 LogMAR, 0.8-0.9 LogMAR (38.4%) in 5 patients and BCVA 0.3-0.8 LogMAR (61.5%) in 8 patients. After 3 months, 13 patients underwent silicone oil extraction. Phacoemulsification was performed on 8 patients with complicated cataract, and intraocular lens implantation was performed on 5 patients. Three patients (23.1%) had proliferative retinopathy at the tumor resection site after surgery, and silicone oil was used again to reposition the retina without intraocular lens implantation. Conclusions: Based on the size and location of the tumor, complete intraocular and extraocular local exfoliation combined with minimally invasive vitrectomy is an effective method for the treatment of choroidal melanoma. It preserves both the eyeball and vision.