ABSTRACT
Objective:To observe the clinical features of uveal metastases from lung carcinoma.Methods:A retrospective case study. From 1983 to 2014, 14 patients with uveal metastases of lung cancer confirmed by ocular examination in Peking Union Medical College Hospital were included in the study. Among them, 7 were male, 7 were female; 11 were monocular and 3 were binocular. The mean age was 54.5±9.6 years. Pathologic examination showed primary bronchial lung cancer, including 13 patients of non-small cell lung cancer (10, 2 and 1 patients of lung adenocarcinoma, squamous cell carcinoma and adenosquamous cell carcinoma, respectively) and 1 patient of small cell lung cancer. Four patients (28.6%) were diagnosed with lung cancer before ophthalmology consultation, and 10 patients (71.4%) were first diagnosed with ophthalmology due to ocular symptoms. The duration from ocular symptoms to lung cancer diagnosis was 1 week to 6 months. The course from diagnosis of lung cancer to ophthalmological consultation was ranged from 10 to 60 months, and the average course was 29.5±19.0 months. There were 7, 4 and 3 patients with impaired vision, occlusion of visual objects and deformation of visual objects, respectively. All patients underwent visual acuity, slit lamp microscope, B-mode ultrasound and UBM examinations. FFA was performed in 8 eyes, and 2 eyes were examined for ICGA. Orbital MRI was performed in 5 patients. Vitreoretinal surgery was performed on 1 eye. The clinical characteristics of the patients were analyzed and observed.Results:In 17 eyes, there were 2 eyes with visual acuity of light perception, 3 eyes of hand movement to counting finger before the eyes, 5 eyes of 0.1- 0.3, 4 eyes of 0.4-0.6, 3 eyes of greater than 0.8. Metastatic cancer was located in iris in 1 eye, it presents as a red mass with irregular shape on the surface, which is full of small nourishing blood vessels. Metastatic cancer were located in choroid in 16 eyes, they presented yellowish-white or grayish-yellow lumps under the posterior pole or equatorial retina, including 14 eyes with a single lesion and 2 eyes with 2 lesions, with retinal detachment in 8 eyes and increased intraocular pressure in 5 eyes. B-mode ultrasonography showed posterior polar flat or surface irregular wavy intraocular space occupying lesions with localized or extensive retinal detachment. FFA and ICGA showed the focal, apical and patchy fluorescence of the tumor. MRI showed that T 1WI medium and high signal consistent with the vitreous body, while T 2WI showed low signal. Conclusions:Uveal metastatic may be the first manifestation of lung cancer, and visual impairment, part of solid mass lesions with fundus flattening may be accompanied by secondary glaucoma and retinal detachment as the main clinical manifestations. Most of the metastatic sites are located in choroid, which is more common in single eye and single lesion. Adenocarcinoma is the most common type of uveal metastasis in non-small cell lung cancer.
ABSTRACT
ObjectiveTo evaluate the anti-glaucoma effect of 1％ D-timolol on patients with primary open-angle glaucoma （POAG） and ocular hypertension （OH）．MethodsThirty-six patients with POAG or OH were included．They were divided into two groups randomly for treating with either 1％ D-timolol or 0.5% L-timolol twice daily．The intraocular pressure（IOP） changes and side effects on eyes and cardiovascular system were noticed．Data of visual field and ocular blood flow were compared with the baseline after given the eyedrops for 3 month．ResultsAfter given one drop of the drug，intraocular pressure dropped significantly in both of the two groups．The IOP day curve at 1 month also dropped when compared with the baseline in both groups．There was no significant difference between the two drugs in magitude of hypotensive effect after 3 months．And the higher the IOP was，the more the IOP dropped when using D-timolol．There were no serious side effects noted．No significant change of ocular blood flow was found by color doppler imagine．Mean sensitivity of visual field was raised significantly in D-timolol-treated group，while in L-timolol-treated group it was not changed much．Conclusion1％ D-timolol is a favorable eyedrop. It is effective and safe for the treatment of glaucoma．