目的:确定虹膜黑色素瘤治疗后继发性青光眼的预测因素。
方法:在眼部肿瘤服务中心保守治疗的虹膜黑色素瘤患者,包括1970年至2016年的威尔斯眼科医院。对图表进行了回顾性审查,并进行二元logistic回归分析。主要结局指标是治疗后青光眼的预测因素,定义为黑色素瘤治疗后眼内压(IOP)>22mmHg。
结果:在271例虹膜黑色素瘤患者中,在就诊时发现40例(15%)与黑色素瘤相关的青光眼,在平均103.7个月(范围:1.0-120.0)的治疗后发生了75例(28%)。比较(管理后青光眼与无青光眼)显示治疗后青光眼患者视力较差(20/50-20/150)(17%vs.5%,p=0.001),增加的平均肿瘤基底直径(5.1毫米与4.3mm,p=0.004),出现时较大的黑色素瘤相关眼压升高(24.1mmHg与16.2mmHg,p<0.001),弥漫性肿瘤形状(9%vs.4%,p=0.01),美国癌症联合委员会(AJCC)T4类别(7%vs.2%,p=0.03),和眼外肿瘤延伸(7%vs.2%,p=0.03)。通过多变量分析确定的治疗后青光眼的危险因素包括出现时黑色素瘤相关的IOP升高(OR:1.1,[1.08-1.22]每1mmHg升高,p<0.001),平均肿瘤基底直径增加(OR:每1毫米增量1.17,[1.02-1.33],p=0.03),高级AJCC临床T子类别(OR:1.23,[1.04-1.46]每1子类别增量,p=0.02)和斑块放疗治疗(OR:2.32,[1.13-4.75],p=0.02)。
结论:虹膜黑色素瘤预测治疗后青光眼的特征包括黑色素瘤相关眼压升高,高级AJCC临床T亚类,增加的平均肿瘤基底直径,和斑块放射治疗。
To identify factors predictive of post-management secondary glaucoma in eyes with iris melanoma.
Patients with iris melanoma who were conservatively managed on the Ocular Oncology Service, Wills Eye Hospital from 1970 to 2016 were included. Charts were retrospectively reviewed, and binary logistic regression analysis was performed. Main outcome measures were factors predictive of post-management glaucoma, defined as intraocular pressure (IOP) > 22 mmHg following melanoma treatment.
Of 271 patients with iris melanoma, melanoma-related glaucoma was identified in 40 (15%) at presentation and post-management glaucoma developed in 75 (28%) at a mean of 103.7 months (range:1.0-120.0). Comparison (post-management glaucoma vs. no glaucoma) revealed patients with post-management glaucoma presented with worse visual acuity (20/50-20/150) (17% vs. 5%, p = 0.001), increased mean tumour basal diameter (5.1 mm vs. 4.3 mm, p = 0.004), greater melanoma-related increased IOP on presentation (24.1 mmHg vs. 16.2 mmHg, p < 0.001), diffuse tumour shape (9% vs. 4%, p = 0.01), American Joint Committee on Cancer (AJCC) T4 category (7% vs. 2%, p = 0.03), and extraocular tumour extension (7% vs. 2%, p = 0.03). Risk factors for post-management glaucoma identified by multivariate analysis included melanoma-related increased IOP at presentation (OR:1.1, [1.08-1.22] per 1-mmHg increase, p < 0.001), increased mean tumour basal diameter (OR:1.17, [1.02-1.33] per 1-millimetre increments, p = 0.03), advanced AJCC clinical T subcategory (OR:1.23, [1.04-1.46] per 1-subcategory increments, p = 0.02) and plaque radiotherapy treatment (OR:2.32, [1.13-4.75], p = 0.02).
Features of iris melanoma that predicted post-management glaucoma included melanoma-related increased IOP on presentation, advanced AJCC clinical T subcategory, increased mean tumour basal diameter, and plaque radiotherapy treatment.