摘要目的 观察脉络膜黑色素瘤敷贴放射治疗(PRT)后黄斑区形态变化.方法 对临床确诊的48例脉络膜黑色素瘤患者的48只眼行125I PRT.患者肿瘤均未累及黄斑区.视力0.02～1.0,平均视力0.4±0.2.治疗前均行光相干断层扫描(OCT)检查,采用放射状6线扫描模式获取黄斑区形态图像.黄斑区形态表现为视网膜脱离者18只眼,占37.5％；视网膜色素上皮(RPE)改变12只眼,占25.0％；水肿、前膜以及脱离伴水肿、渗出和RPE改变者7只眼,占14.6％；黄斑区视网膜形态基本正常11只眼,占22.9％.治疗后随访1～24个月,平均随访时间(10.4±5.9)个月.随访观察患眼肿瘤控制以及视力变化情况,并以治疗前相同的设备和方法进行黄斑区形态的OCT检查.对比观察治疗前与治疗后末次随访黄斑区形态的变化；分析黄斑形态变化与PRT以及视力变化的关系和影响因素.结果 48例患者经PRT后肿瘤控制良好.视力提高2例,占4.2％；视力不变10例,占20.8％；视力下降36例,占75.0％.治疗前后视力差异有统计学意义(Z=-3.778,P＜0.05).末次随访OCT检查,黄斑区形态表现为视网膜脱离者13只眼,占27.1％；RPE改变9只眼,占18.8％；水肿,脱离伴水肿、渗出和RPE改变者17只眼,占35.4％；增生、萎缩、脱离伴出血渗出和水肿前膜者6只眼,占12.5％；黄斑视网膜形态基本正常3只眼,占6.3％.15例患者呈现两种及两种以上的黄斑区形态异常变化,占31.3％.结论 PRT后脉络膜黑色素瘤患者黄斑区形态异常主要表现为视网膜脱离、RPE改变、黄斑水肿、渗出.黄斑区结构异常的比例增加,31.3％的患者呈现两种及两种以上的黄斑区形态异常.

abstractsObjective To observe the macular morphological changes of choroidal melanoma with coherence tomography (OCT) after plaque radiotherapy (PRT).Methods A total of 48 patients (48 eyes)with choroidal melanoma who underwent 125I PRT were enrolled in this study.All the patients were examined documenting OCT to get the image of macula.The macula of all the patients was not involved.The median visual acuity was 0.4±0.2,which ranged from 0.02 to 1.0.There were 18 eyes (37.5％) with retinal detachment,12 eyes (25.0 ％) with retinal pigment epithelium (RPE) changes,seven eyes (14.6 ％)with macular edema, epimacular membrane, detachment combined with edema, exudation and RPE changes,11 eyes (22.9％) with normal macular structure.The median follow-up time was (10.4 ±5.9)months,which ranged from one to 24 months.The tumor control situation and visual acuity were observed in follow-up period.The same equipment and methods of OCT were used to return visit in follow-up period.The macular morphological changes at the final visit and its relationship with PRT and visual acuity werecontrastively analyzed.Results All the patients had good control of tumor.The vision acuity improved in two eyes (4.2％),unchanged in 10 eyes (20.8％),and decreased in 36 eyes (75.0％).The differences of the visual acuity was statistically significant between before and after treatment (Z=-3.778,P＜0.05).There were 13 eyes (27.1％) with retinal detachment; nine eyes (18.8％) with RPE changes; 17 eyes (35.4％) with macular edema,detachment combined with edema,exudation and RPE changes; six eyes (12.5 ％) with proliferation,atrophy,detachment combined with edema,exudation and epimacular membrane;three eyes (6.3％) with normal macular structure.There were 15 patients (31.3％) with two or more abnormal macular morphology after PRT.Conclusions Retinal detachment,RPE changes,macular edema and exudation are common abnormal macular morphology after PRT.The incidence rate of abnormal macular morphology is increased.There are 31.3 ％ patients with two or more abnormal macular morphology.