经瞳孔温热疗法治疗三种眼底良性肿瘤

Transpupillary thermotherapy for three kinds of intraocular benign tumors

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810nm半导体红外激光，光斑3．0mm，按肿物大小连接照射1～5个光斑。功率360～1200mw，时间60～80S。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。

Objective To evaluate the efficacy of transpupillary thermotherapy （TTT）on three kinds of intraocular benign tumors. Methods Seventeen patients with 3 kinds of intraocular tumors, 3 eyes of 3 patients with papillary hemangioma, 9 eyes of 9 patients with choroidal hemangioma and 8 eyes of 5 patients with choroidal osteoma were treated with transpupillary thermotherapy. All patients underwent pretreatment ocular examination,including visual acuity, biomicroscopy for anterior segment and fundus examination ,fundus fluorescein and indocyanine green angiography,optic coherence tomography,perimetry test,uhrasonography,and CT. TTT was conducted with infrared diode laser at810nm, with power of 360- 1 200 raW,beam diameter of 3 mm or combined 2-5 spots according to the tumor size;the exposure time was 60-80 seconds. The treatment was completed in one session, and another treatment was given 1-3 month later if active leakage demonstrated. The follow-up period was 6-36 months（mean 14.5 month）. Results The best corrected visual acuity with Snellen chart on average for papillary bemangioma was 0. 17 before TTT and 0.27 afterl;for choroidal hemangioma was 0.39 before TTT and 0.46 after;for choroidal osteoma was 0. 20 before TTT and 0.31 after. Three eyes with papillary hemangioma had operation to release subretinal fluid and intraocular laser coagulation; the tumor remained reddish color with dilated vessels and patches of hemorrhages on the surface. After TTT the color appeared pale yellowish, hemorrhages absorbed,subretinal fluid subsided,and choroidal retinal atrophy disclosed along the lower border of the tumor. In 9 eyes with choroidal hemangioma, the red-light area disappeared, subretinal fluid subsided, and the pigment proliferation in the treatment area was found. Eight eyes with choroidal osteoma bad cboroidal neovessels and macular hemorrhages; after TTT blood disappeared, subretinal fluid absorbed ,and the color of tumor showed pale yellow with dark pigment and thin scar tissue. There was no significant complication associated with TTT. Conclusions Transpupillary thermotherapy is effective on papillary hemangioma,circumscribed choroidal hemangioma and choroidal osteoma either as preliminary or supplementary treatment.