Ocular complications after iodine brachytherapy for large uveal melanomas
Ocular complications after iodine brachytherapy for large uveal melanomas
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DOI：
10.1016/j.ophtha.2004.03.027
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发表时间：
2004-09-01
期刊：
影响因子：
13.7
通讯作者：
Kivelä, T
中科院分区：
文献类型：
--
作者：
Puusaari, I;Heikkonen, J;Kivelä, T
目的：评价碘125斑块近距离放射治疗（IBT）治疗大葡萄膜黑色素瘤后的前后段并发症及其处理。设计：回顾性非随机干预性研究。参与者：96例大葡萄膜黑色素瘤患者，符合眼黑色素瘤协作研究标准。患者接受初次IBT（肿瘤尖端的中位剂量，87戈伊）。中位肿瘤高度和直径分别为10.7 mm（范围，4.5-16.8）和16.5 mm（范围，7.3-25.0），中位随访时间为3.5年（范围，0.3-10.4）。累积发病率分析和竞争风险回归用于分析个体并发症的时间并识别风险因素。死亡和继发性眼球摘除作为竞争风险进行分析。主要结局指标：白内障、虹膜新生血管、青光眼、黄斑病变、视神经病变、玻璃体出血和持续性渗出性视网膜脱离（RD）。白内障、虹膜新生血管和青光眼的5年累积发病率为69%（95%置信区间[CI]，57%-78%）、62%（95% CI，50%-71%）和60%（95% CI，48%-70%）。后节并发症较少见。黄斑病变和视神经病变的5年发生率分别为52%（95%CI，35%-65%）和46%（95%CI，30%-61%），玻璃体积血和持续性RD的5年发生率分别为36%（95%CI，23%-48%）和25%（95%CI，15%-36%）。超过80%的并发症在3年内被诊断出来。白内障是最早出现的并发症。除白内障外，未发生特定并发症的死亡累积发生率是首次发生并发症的0.24 ~ 0.62倍。肿瘤高度的增加与邻近组织的剂量增加相关，与白内障（P = 0.017）、虹膜新生血管形成（P = 0.087）和RD（P = 0.046）的时间相关。黄斑病变和视神经病变主要分别与到中心凹（P = 0.015）和视盘（P = 0.015）的距离相关。在57例白内障患者中，47%接受了白内障摘除术，51例青光眼患者中有12%接受了睫状体光凝术。白内障，眼内压升高，RD的患病率分别为43%，39%，和13%，分别在5 years.Conclusions：IBT后眼部并发症的发生率显着影响竞争风险。累积发病率和患病率分析为患者咨询提供了现实的估计。(C)2004年，美国眼科学会。
Purpose: To evaluate anterior and posterior segment complications and their management after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma.Design: Retrospective nonrandomized interventional study.Participants: Ninety-six patients with a large uveal melanoma according to the Collaborative Ocular Melanoma Study criteria.Methods. The patients underwent primary IBT (median dose to tumor apex, 87 Gy). The median tumor height and diameter were 10.7 mm (range, 4.5-16.8) and 16.5 mm (range, 7.3-25.0), respectively, and the median follow-up time was 3.5 years (range, 0.3-10.4). Cumulative incidence analysis and competing risks regression were used to analyze the time to individual complications and to identify risk factors. Death and secondary enucleation were analyzed as competing risks.Main Outcome Measures: Cataract, iris neovascularization, glaucoma, maculopathy, optic neuropathy, vitreous hemorrhage, and persistent exudative retinal detachment (RD).Results: The 5-year cumulative incidences of cataract, iris neovascularization, and glaucoma were 69% (95% confidence interval [CI], 57%-78%), 62% (95% CI, 50%-71 %), and 60% (95% CI, 48%-70%), respectively. Posterior segment complications were less common. The 5-year incidences of maculopathy and optic neuropathy were 52% (95% CI, 35%-65%) and 46% (95% CI, 30%-61 %), and those of vitreous hemorrhage and persistent RD were 36% (95% CI, 23%-48%) and 25% (95% CI, 15%-36%), respectively. More than 80% of complications were diagnosed within 3 years. Cataract was the earliest complication to appear. Except for cataract, the cumulative incidence of dying without developing a particular complication was 0.24 to 0.62 times that of first developing the complication. Increasing tumor height, which correlates to increasing doses to adjacent tissues, was associated with time to cataract (P = 0.017), iris neovascularization (P = 0.087), and RD (P = 0.046). Maculopathy and optic neuropathy were associated primarily with distance to the fovea (P = 0.015) and optic disc (P = 0.015), respectively. Of 57 patients with cataract, 47% underwent cataract extraction, and 12% of 51 patients with glaucoma were treated with cyclophotocoagulation. The prevalences of cataract, elevated intraocular pressure, and RD were 43%, 39%, and 13%, respectively, at 5 years.Conclusions: The frequency with which ocular complications develop after IBT is notably influenced by competing risks. Cumulative incidence and prevalence analysis provide realistic estimates for patient counseling. (C) 2004 by the American Academy of Ophthalmology.