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W. Wei, W. Yang, S. Hu, B. Li, X. Zhu, X. Sun, H. Song; Long-Term Follow-Up of Local Excision of Ciliary Body Tumor. Invest. Ophthalmol. Vis. Sci. 2008;49(13):35.
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To investigate the long-term effects, complications and safety of local excision of ciliary body tumors which were diagnosed with clinical examinations, ultrasonic biomicroscopy (UBM) and pathological examinations.
Twenty-two patients (8 males and 14 females, mean age 36.2 years) diagnosed with ciliary body tumors by UBM and type-B ultrasound between 1996 and 2001 were enrolled in this study. Eleven patients had the tumors in the left eye, while the rest 11 had the tumors in the right eye. The maximum diameter of the tumor ranged from 4mm to 16mm. Six patients had localized opacity on their crystalline lens; 3 had complete lens opacity and 4 had retinal detachment. Localized slab sclera-ciliary-body excision or localized slab sclera-ciliary-body-anterior-choroid excision with vitrectomy and scleral graft transplantation procedures were performed to excise the tumor. Patients were under general hypotension anesthesia during the surgeries. Pathological examinations were performed on the excised tumors.
Pathological results showed there was 41% (n=9) of malignant ciliary body melanoma, of which 3 were mixed-cell type, 1 was epithelioid-cell type and 5 were fusocellular type. There was 27% (n=6) of nonpigmented ciliary epithelial adenoma; 18% (n=4) of melanophore tumor; 9% (n=2) of neurofibroma and 5% (n=1) of neurinoma. The duration of follow-up ranged from 3 years to 8.25 years (mean 4.5 years) after the surgery. None of the patients showed apparent changes in ocular shape; 6 of them maintained circular pupils; and 7 were implanted with anterior chamber intraocular lens. Two had intraocular pressure lower than 10mmHg; 3 patients had obvious fibroplasia around the incision site; 1 had local retinal detachment. Tumor re-grew in one patient which resulted in enucleation. Hepatic metastasis was found 2.5 years after the surgery in one patient with malignant ciliary melanoma (epithelioid-cell type) which exceeded 15mm in diameter. The range of best corrected visual acuities was between 20/800 to 20/20 after surgery; 15 of them were above 20/60 (measured by Tumbling E chart).
59% of the ciliary body tumors were carcinoid. UBM is a very useful instrument for early diagnosis of the ciliary body tumor and determining its relation with surrounding tissues. Local excision of the ciliary body tumor Combined with vitrectomy can maintain ocular shape; retain vision; aid pathological diagnosis; and minimize complications. It is an effective method to treat some malignant and carcinoid tumors of the ciliary body. The long-term follow-up is important for ciliary body melanoma cases.
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