中华眼底病杂志

中华眼底病杂志

脉络膜色素痣的研究现状及进展

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脉络膜色素痣是眼底常见的良性黑色素细胞性肿瘤,患病率为0.15%~10.00%。男性患病率高于女性。白色人种患病率高,有色人种患病率低。其继发的视网膜下积液或脉络膜新生血管等视网膜病变可能损害视力。脉络膜色素痣存在恶变为黑色素瘤的风险,恶变危险因素包括脉络膜色素痣厚度、视网膜下积液、视觉症状、橘红脂样色素改变、瘤体边缘接近视盘、超声检查显示瘤体内呈挖空表现和周边晕消失等。临床上早期识别可能损害视力的相关征象对于尽早治疗和良好预后具有重要意义,尤其是监测其是否有恶变趋势更是非常必要。光相干断层扫描对脉络膜色素痣细节的评估有助于其诊断、鉴别和监测随访,其结合光相干断层扫描血管成像正逐渐成为观察脉络膜黑色素细胞性病变的重要手段。今后应加强相关方面的研究,为深入揭示该类疾病的特点和本质提供更多精细化信息。关于脉络膜色素痣的治疗,已证实激光光凝、光动力疗法及玻璃体腔注射抗血管内皮生长因子药物对其继发病变均有效。

Choroidal nevus is one of the most common benign melanocytic tumor. The prevalence rate of choroidal nevi is 0.15% - 10.00%, which is high among whites and low among colored people, and is obvious higher in male than that in female. Secondary changes in the surrounding retina of the benign tumor, such as subretinal fluid and choroidal neovascularization, may result in vision loss. This benign tumor carries risks for transformation into malignant melanoma. The factors predictive of transformation into melanoma included greater thickness, subretinal fluid, visual symptoms, orange lipofuscin pigment, tumor location (tumor margin near optic disc), ultrasonography hollowness and absence of halo. Early identification of the related features which impair visual acuity is important for early treatment and better prognosis, and it is especially important to monitor the tendency of malignant transformation. Optical coherence tomography (OCT) could provide detailed information which aid in diagnosing, differentiating and monitoring of choroidal nevi. OCT and optical coherence tomography angiography are emerging as excellent techniques to investigate choroidal melanocytic lesions. The treatment modalities, such as laser photocoagulation, photodynamic therapy and intravitreal anti-vascular endothelium growth factor, have been proved to be effective for choroidal nevi with secondary changes. In the future, the relevant researches should be imposed to provide more detailed information in order to explore the nature and characteristics of this disease.

关键词: 脉络膜疾病/诊断; 脉络膜疾病/治疗; 痣,色素; 综述

Key words: Choroid diseases/diagnosis; Choroid diseases/therapy; Nevus, pigmented; Review

引用本文: 李海东, 沈丽君. 脉络膜色素痣的研究现状及进展. 中华眼底病杂志, 2018, 34(2): 190-193. doi: 10.3760/cma.j.issn.1005-1015.2018.02.024 复制

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