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.

Diagnosis and treatment of diffuse choroidal hemangioma

Objective To discuss the diagnosis,treatments and their efficacy for diffuse choroidal he-mangioma(CH).Methods Four patients (4 eyes), age from 6 to 19 years old, with diffuse CH and exudative retinal detachment were reviewed.One presented with glaucoma.Three cases associated with facial nevus flam-meus and three with combination of leptomeningeal venous angiomatosis.One case received conservative treat-ment with medication.Photodynamic therapy (PDT)was performed 2 or 3 times as an initial treatment in two cases and as secondary treatment after failure of Transpupillary thermotherapy (TTT)in another case.Visual acuity, intraocular pressure (IOP), fundus photography and B-scan ultrasonography were examined before and after treatment.Results Patient with conservative treatment finally got blind one month later because of per-sistence of high lOP and complete retinal detachment.While in PDT cases, totally absorption of subretinal flu-id,partially reduction of tumor, stabilization of IOP and visual acuity were achieved after treatment.PDT was also effective in case after failure of TTT.Conelusion Though tumor could not disappear thoroughly, subreti-ual fluid could be absorbed and visual acuity could be stabilized after PDT.It may be a useful alternative treat-ment for diffuse CHs.