脉络膜骨瘤的临床表现和治疗探讨

Long-term fellow-up and management of choroidal osteoma

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。

Objective To report the clinical characteristics, long-term follow-up and management of choroidal osteoma. Methods Eighteen eyes of 12 cases （5 male and 7 female） of choroidal osteoma were studied. Best corrected vision, intraocular pressure, perimetry, anterior segment and eye fundus were examined routinely. Special tests included photochrome of eye fundus, fluorescein angiography and/or indocyanine green angiography; B-ultrasonogram, CT, perimetry and electrophysiology. （ 1 ） Eight eyes of 6 cases treated with vitamins and anti-inflammatory drug and followed-up periodically for 1-26 years （median 2. 5 years）. （2） Four eyes of 2 cases were treated with Krypton laser photocoagulation, 2 of them were superimposed with transpupillary thermotherapy （TTT）. （ 3 ） TTT was given primarily for 6 eyes of 4 cases with infrared dioned laser; the spot size was 3 mm, 1-5 spots were conducted conjunctly to cover the tumor surface. Power was 800-1200 mw at 60-90 seconds. The procedure was completed in 1-3 secessions with an interval of 4-6 weeks. Results （ 1 ） In the medical treatment group, gradual growth of the tumor with pseudopodium along the margin was disclosed. One eye showed spontaneously regression during the long- term follow-up. （2） Laser photocoagulation was effective for 2 eyes, but residual flat serous detachment around the optic disc persisted in another 2 eyes and subsided with TTT. （3） Choroidal osteoma complicated with CNV treated primarily with TTT, prominent improvement was demonstrated. Conclusions Choroidal osteoma grows gradually in the natural course and shows pseudopodial margin. Laser photocoagulation was effective for certain cases. TTT is a method of choice either used primarily or supplementary after laser photocoagulation, it is recommended for cases complicated with CNV.