Finger虹膜切除术:眼前节肿瘤的小切口活检

Aims: To develop a minimally invasive, maximally effective method to biopsy an terior segment tumours. Methods: A 25 gauge aspiration cutter (vitrector) was us ed to biopsy anterior segment tumours. The probe was introduced under sodium hya luronate 1%and through a 1 mm incision. Aspiration (600 mm Hg) cutting (300 cpm ) was performed to obtain specimens for cytology and histopathology. Results: Di agnostic material was obtained in nine of 10 (90%) cases. Diagnoses included ir is naevus, iris stroma, malignant melanoma, melanocytoma, epithelial inclusion c yst, and sarcoid granuloma. All corneal wounds were self sealing. One patient de veloped a transient postoperative increase in intraocular pressure. Within the f ollow up of this study, no patients suffered intraocular haemorrhage, infection, cataract or vision loss. Conclusion: The Finger iridectomy technique was a mini mally invasive and very effective biopsy technique. Aspiration cutting yielded r elatively large pieces of tissue (and cells) used for cytopathological and histo pathological evaluation. Small incision surgery allowed for rapid rehabilitation and no significant complications.

局部应用丝裂霉素治疗结膜恶性黑色素瘤及原发性获得性不典型黑变病:12年经验总结

PURPOSE: To report 12-year follow-up experience with topical mitomycin chemotherapy for diffuse and multifocal primary acquired melanosis (PAM) with atypia and conjunctival melanoma. Methods: Interventional case series of 16 patients. Mitomycin was a primary treatment for residual epithelial disease in ten patients (eight with PAM with atypia and two with conjunctival melanoma) and as an adjuvant to excision and cryotherapy in six with conjunctival malignant melanoma. Primary treatments consisted of mitomycin 0.04%qid for 28 days (two 14-day cycles) and for 7 consecutive days as adjuvant therapy. Patients were followed for both local recurrence and metastatic disease. Results: Sixteen patients were followed for a mean 81 months (range 13-144 months) after treatment. All tumors responded to chemotherapy. Recurrence was noted in eight (three adjuvant and five primary treatment patients). Three underwent orbital exenteration. The remaining five were treated conservatively. The mean time to recurrence was 36.9 months. The short-term mitomycin-related complications included transient keratoconjunctivitis (n=14), severe keratoconjunctivitis (n=1) and one corneal abrasion with scar formation. The longterm complications included pannus (n=2) and corneal haze (n=1). Visual acuity was maintained within two lines in 14 patients (including measurements just prior to exenteration). Three patients died, one of metastatic conjunctival melanoma. Conclusions: Conjunctival melanoma and PAM responded to mitomycin 0.04%topical chemotherapy; subepithelial nests appeared resistant to treatment. Treatment-related complications were acceptable. In this series, as primary and adjuvant therapy, topical mitomycin yielded an overall recurrence rate of 50%.

“指尖”冷冻治疗探头:治疗鳞状及黑素细胞性结膜肿瘤

Aim: To describe the use of a new speculated cryoprobe in treatment of conjunc tival neoplasia. Methods: A new cryoprobe design was submitted to Mira, Inc resu lting in new hand held probes capable of producing homogeneous freezing over lar ge surface areas. The active surface of the small, medium, and large spatulated probes are 8.5 mm2, 25.2 mm2, and 70 mm2. End freezing reduces the possibility o f inadvertent freezing of adjacent tissues (outside the targeted zone). In this series, the probes were employed to treat patients with squamous and melanocytic conjunctival neoplasia. Results: 12 consecutive patients with malignant conjunc tival neoplasia were treated with these new cryotherapy probes. Techniques of pr obe construction and clinical use are described. Cryoburns of the cornea, sclera , and conjunctiva were formed and recorded by digital photography. Ophthalmic ex aminations before and after surgery demonstrated that no acute intraocular or ad nexal complications occurred. No loss of visual acuity could be attributed to th is use of the cryoprobes. Conclusion: “Finger-tip”cryoprobes were used to tre at malignant conjunctival neoplasia (squamous and melanocytic). Probe design all owed for uniform freezing over large surface areas. This cryoprobe design appear s to be ideal for treatment of conjunctival tumours.

钯103(103 Pd)敷贴放射治疗伴有视网膜脱离的局限性脉络膜血管瘤

Objective: To describe clinical experience with palladium 103 ( 103Pd) ophthalmic plaque radiotherapy for choroidal hemangioma. Methods: One course of 103Pd ophthalmic plaque radiotherapy was used in each of 5 patients with circumscribed choroidal hemangioma who had progressive loss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900 rad) was delivered. Functional tests of outcome included bestcorrected visual acuity. Anatomic results included changes in tumor height and subretinal fluid documented by ophthalmoscopy, fluorescein angiography, and ultrasonography. Results: All patients had complete resolution of sub- retinal fluid with reattachment of the retina. All. tumors decreased in height (mean, 50% ) after treatment. Three patients (60% ) demonstrated improvement in visual acuity at the last follow- up, and in 1 patient vision remained stable with resolution of metamorphopsia. Twenty- four months after treatment, 1 patient whose visual acuity had recovered from 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy. For all patients, a mean visual acuity improvement of 2 lines was documented (95% confidence interval, 0.23- 0.88). Mean follow- up was 18.6 months (range, 6- 29 months). Conclusions: A single 103Pd plaque radiation treatment was effective in decreasing tumor height, eliminating sub- retinal fluid, and improving visual acuity in patients with symptomatic circumscribed choroidal hemangiomas.

小切口虹膜切开术和虹膜切除术

Purpose:To describe a minimally invasive method to create a full-thickness surgical iridectomy.Design:An interventional case series.Methods:Surgical iridectomies were performed through a 1 mm clear corneal incision.The anterior chamber was prepared with acetylcholine chloride 10 mg/ml and sodium hyaluronate 1%.A 25-gauge aspiration-cutter “ probe" was introduced through the corneal incision such that the aspiration portal was occluded by the iris stroma.Then aspiration(600 mm/Hg)cutting(300 cpm)was used to create a surgical iridotomy in 2 cases.Then the probe was removed.Results:Full-thickness iridotomies were created.None of the patients were noted to have a secondary increase in intraocular pressure,hyphema,infection,cataract or vision loss.The clear-corneal wounds were self-sealing.Conclusions:Small incision surgical iridectomy can be minimally invasive and effective.Use of a 25-gauge aspiration-cutting probe allowed for small incision surgery,rapid rehabilitation and no significant complications.

“指尖状”冷冻探头辅助的眼球摘除术

] PURPOSE: To report the use of a new cryotherapy probe to induce proptosis duri ng enucleation surgery. DESIGN: Interventional case report. METHODS: Two patient s with uveal melanoma and secondary glaucoma were treated by enucleation. A larg e surface area (70 mm2), spatulated, end-freezing cryotherapy probe (“Finger- tip”probes, MIRA, Inc.) was used to induce proptosis during optic nerve transse ction. RESULTS: This new probe offers homogeneous freezing over a relatively lar ge surface area. This new cryoprobe was used to create a large cryo-adhesion on the cornea, for an excellent purchase of the eye during enucleation surgery. Us ing this adhesion, the eye was lifted, enabling transsection of the optic nerve. CONCLUSIONS: This report includes photographs of the cryoprobe, the corneal cry o-adhesion, and describes its use for traction during enucleation surgery.

LASIK术后1个月的反应性淋巴增生

Purpose: This study was conducted to investigate a case of reactive lymphoid hyperplasia following laser assisted in situ keratomileusis (LASIK). Methods: A 31- year-old man who underwent LASIK presented 1 month later with a fleshy conjunctival (plical) tumor in the left eye. An excision biopsy of the tumor was performed. Results: Histopathology of the excised tumor revealed reactive lymphoid hyperplasia. Discussion: Conjunctival lymphomas can masquerade as chronic conjunctivitis and can be preceded by reactive lymphoid hyperplasia. It is important to identify and differentiate these tumors. This report describes the unusual occurrence of a lymphoid conjunctival tumor after LASIK eye surgery.