鼻咽癌放射治療後之放射線視網膜病變

Radiation Retinopathy after Radiotherapy for Nasopharyngeal Carcinoma

陳墩祿(Tun-Lu Chen) ； 楊克仁(Ko-Jen Yang)

《中華民國眼科醫學會雜誌》 34卷3期 (1995/09) Pp. 335-342

摘要

本篇報告鼻咽癌患者接受放射治療後，發生之放射線視網膜病變。共分析15位病人之26隻眼睛，由完成放射治療到發生視網膜病變之時間為10到72個月，平均24個月。其眼底所見如視網膜出血、棉絮狀斑點、硬滲出物、微血管瘤、黃斑部水腫、新生血管及玻璃體出血等。眼底螢光攝影則可見視網膜微血管之變化，如微血管擴張及微血管無淮流區等。追踪時間為6到50個月，平均24個月。
有5隻眼睛因嚴重之微血管無灌流區或黃斑部水腫而接受雷射光凝固治療；有2隻眼睛因玻璃體出血接受玻璃體手術，術後視力皆有改善或保持穩定。
本文並討論放射治療前之眼科檢查、放射治療計畫、治療中之等劑量曲線圖及術後跟科追踪檢查之畫要性，藉以早期偵知放射備見網膜病變，並及時施以適當治療以減少嚴重併發症之發生。

並列摘要

Radiation retinopathy is a complication of the therapeutic irradiation of posterior nasal space or periorbital structures. The authors analyzed 26 eyes of 15 patients who developed retinopathy following radiotherapy (external beam irradiation) for nasopharyngeal carcinoma. Ages at the time of diagnosis ranged from 30 to 61 years, with a mean age of 45.2 years. Eight of the patients were men and seven were women. The latent periods from the termination of radiotherapy until the development of radiation retinopathy ranged from 10 to 72 months, with a mean of 24 months.
The ophthalmic manifestations include retinal hemorrhages, cotton-wool spots, hard exudates, microaneurysms, macular edema, neovascularization and vitreous hemorrhages. Fluorescein angiography reveals retinal microvascular changes such as retinal capillary dilatation or nonperfusion. Photocoagulation treatment was performed in 5 eyes with severe retinal capillary nonperfusion or macular edema. Pars plana vitrectomy was used for nonclearing vitreous hemorrhage in 2 eyes.
The authors also discuss the importance of the ocular examination before the radiotherapy, the precise treatment planning, the usage of the isodose curve and the follow-up ocular examination.

並列關鍵字

Nasopharyngeal carcinoma ； Radiation ； Radiotherapy ； Retinopathy