【作者】 刘涛；

【导师】 柳小丽；

【作者基本信息】 吉林大学 ， 临床医学硕士（眼科学）（专业学位）， 2022， 硕士

【摘要】 目的:虹膜转移癌在临床上相对少见,部分病人在全身病灶确诊之前,以眼部不适首诊于眼科,因其临床表现类似于葡萄膜炎,容易给患者造成误诊误治。因此本研究的目的是通过研究和总结虹膜转移癌的临床特征、以及原发癌的具体特点,提升对虹膜转移癌的认识,促进虹膜转移癌的早诊断、早治疗,提高其临床预后。方法:以“(IRIS[Title])AND METAST~*[Title]”为检索式在Pubmed数据库中检索所有相关的文献资料。将明确诊断为虹膜转移癌的病例纳入研究,收集患者的详细资料,包括发病年龄、性别、眼部表现、原发肿瘤的位置、整理虹膜转移灶的特征、眼部症状、眼科检查结果、视力和眼压等。结果:截止到2019年9月,共检索到符合入排标准的相关文献108篇,125例患者133只眼被确诊为虹膜转移癌。其中男性70例,女性50例,性别未明5例;平均年龄56±15岁,左眼60例,右眼49例,双眼8例,眼别不详8例;最常见的原发肿瘤为肺癌(42%)和乳腺癌(15%)。约三分之一患者以眼部不适首诊于眼科,进一步检查发现原发肿瘤病灶。22%患者虹膜转移发生于全身其它部位转移之前,33%发生于其它部位转移之后。最常见的主诉为视力下降和眼疼,临床表现以虹膜肿物和前房炎症为主,虹膜肿物多位于虹膜根部,表现为虹膜结节,颞侧(24%)多见,多位于虹膜根部,多为白色或橘红色,15例(20%)有虹膜新生血管,57例(64%,N=90)伴有眼压升高。细针穿刺活检或切除组织病理检查有助于确诊。局部给予放射治疗或眼内注射抗VEGF药物治疗,可缓解眼部不适和控制眼压。结论:虹膜结节,伴有眼压升高和新生血管是虹膜转移癌的临床特征。最常见的原发性肿瘤是肺癌和乳腺癌。虹膜转移癌可早于原发病灶出现临床症状,临床表现为视力下降和疼痛,局部组织病理可明确诊断,治疗及预后与原发病灶的严重程度有关。更多还原

【Abstract】 Purpose:Iris Metastases is relatively rare in clinica.Some patients are referred to ophthalmologic clinic with ocular discomfort before the diagnosis of primary lesions.Because the clinical manifestations of iris Metastases are similar to uveitis,it is often misdiagnosed and mistreated as uveitis.Therefore,in order to improve the understanding of iris metastases,promote early diagnosis and early treatment of iris metastases,and improve their clinical prognosis,we will study the clinical features of iris metastases and the specific characteristics of primary cancers.Method:All relevant literatures were searched in the Pubmed database with the search formula "(IRIS[Title])AND METAST*[Title]".Cases with definite diagnosis of iris metastases were included,and detailed information of the patients was collected,including age of onset,gender,ocular manifestations,location of primary tumor,characteristics of iris metastases,ocular symptoms,ophthalmic examination results,visual acuity and intraocular pressure,etc.Result:Up to September 2019,a total of 108 related literatures were retrieved,and 133 eyes of 125 patients were diagnosed with iris metastases.There were 70 males and 50 females,5 cases of unknown gender;mean age was 56±15 years,60 left eyes and 49 right eyes,8 cases with both eyes,8 cases with unknown eyes;the most common primary tumors were lung cancer(42%)and breast cancer(15%).About one third of the patients were first diagnosed with eye discomfort in the ophthalmology department,and the primary tumor lesions were found in further examinations.Iris metastases occurred in 22% of patients before metastases in other parts of the body,and 33% after metastases in other parts of the body.The most common complaints were vision loss and eye pain.The main clinical manifestations were iris mass and anterior chamber inflammation.The iris mass was mostly located at the root of the iris.Manifested as iris nodules,more common in the temporal side(24%),mostly located at the root of the iris,mostly white or orange-red,15 cases(20%)had iris neovascularization 57 cases(64%,N=90)had There is increased intraocular pressure.Fine-needle aspiration biopsy or excisional histopathology can help confirm the diagnosis.Local administration of radiation therapy or intraocular injection of anti-VEGF drugs can relieve eye discomfort and control intraocular pressure.Conclusion:Iris nodules with elevated intraocular pressure and neovascularization are clinical features of iris metastases.The most common primary tumors are lung and breast cancer.The clinical symptoms of iris metastases may appear earlier than the primary lesions,and the clinical manifestations are vision loss and pain.The local histopathology can be clearly diagnosed.The treatment and prognosis are related to the severity of the primary lesions.更多还原