国产敷贴器治疗孤立性脉络膜血管瘤的临床效果

The Safety and Efficacy of a Domestic Radioactive Applicator for the Treatment of Circumscribed Choroidal Hemangioma

目的:评价国产敷贴器治疗孤立性脉络膜血管瘤的临床疗效。方法:回顾性系列病例研究。选择2010年2月至2018年8月于北京同仁眼科中心临床和影像学确诊为孤立性脉络膜血管瘤患者43例(43眼),所有患者都存在渗出性视网膜脱离,经国产敷贴器进行巩膜外敷贴放射治疗。彩色超声多普勒测量瘤体大小(最大基底直径和最大高度),间接眼底镜、光学相干断层扫描观察视网膜下液情况,比较术前和末次随访时视力、眼压、瘤体大小及视网膜下液的变化,并观察有无并发症的发生。治疗前后瘤体最大基底径、瘤体高度比较采用配对t检验进行分析,治疗前后视力、眼压比较采用Wilcoxon秩和检验进行分析。结果:43例患者末次随访LogMAR视力(2.03±1.45)与术前(2.14±1.36)比较,差异有统计学意义(Z=-2.348,P=0.019)。末次随访眼压为(13.6±6.0)mmHg(1 mmHg= 0.133 kPa)与术前的(12.5±4.2)mmHg比较,差异无统计学意义(Z=-1.419,P=0.3)。末次随访瘤体最大基底直径为(10.3±2.5)mm,较术前的(12.3±3.2)mm缩小,差异有统计学意义(t=8.862,P<0.001);末次随访瘤体高度为(2.6±1.3)mm,较术前的(4.8±1.4)mm降低,差异有统计学意义(t=10.387,P<0.001)。所有患者在末次随访时视网膜下液完全吸收,未观察到放射性视神经病变、视网膜病变、黄斑病变或放射性白内障的发生。结论:国产敷贴器巩膜外敷贴可以使孤立性脉络膜血管瘤的瘤体缩小,视网膜下液吸收,从而避免眼球摘除,并保留视功能。

Objective: To evaluate the clinical efficacy of a domestic radioactive applicator for the treatment of circumscribed choroidal hemagioma. Methods: This was a retrospective consecutive observational study. Forty-three patients were diagnosed clinically and radiologically with circumscribed choroidal hemagiomain Beijing Tongren Hospital from February 2010 to August 2018. All patients had exudative retinal detachment and were treated by a domestic radioactive applicator. The size of the tumor (maximum base diameter, maximum height) was recorded by color doppler ultrasound imaging (CDI). Changes insubretinal fluid were observed by indirect ophthalmoscopy and optical coherence tomography (OCT). The changes invisual acuity, intraocular pressure, tumor size and subretinal fluid were compared before and after surgery and the occurrence rates of complications were noted. Data were compared by a paired t-test and Wilcoxon rank sum test. Results: There was a statistically significant difference in visual acuity between the most recent follow-up (2.03±1.45) and pre-operation (2.14±1.36)(Z=-2.348, P=0.019), and no significant difference in intraocular pressure between the most recent follow-up (13.6±6.0 mmHg) and pre-operation (12.5±4.2 mmHg)(Z=-1.419, P=0.3). Tumor size had regressed compared to pre-operative measurements inmaximum basal diameter: The most recent follow-up was 10.3±2.5 mm, pre-operation was 12.3±3.2 mm (t=8.862, P<0.001);maximum height: the most recent follow-up was 2.6±1.3 mm, pre-operation was 4.8±1.4 mm (t=10.387, P<0.001). Subretinal fluid was not observed in any patients. Furthermore, damages to the optic nerve, retina and macula or radiational cataract were not observed. Conclusion: A domestic radioactive applicator can be used to treat circumscribed choroidal hemagioma, which can cause the tumor to regress, lead to absolute absorption of the subretinal fluid, avoid enucleation and protect visual function.