Tumors of a horioidea are a group of pathological formations of a vascular wall which includes a nevus, a uvealny melanoma and gemangiy. During a long period clinical symptoms are absent. Decrease in visual acuity and a strabizm arise only at increase in diameter of a new growth. Diagnosis of tumors of a horioidea is based on carrying out an oftalmoskopiya, vizometriya, the PHAGE, biomicroscopy, OCT, BRIDLES. Depending on a disease form tactics of treatment comes down to carrying out laser coagulation, cryotherapy, brachytherapy, photodynamic therapy, transpupillyarny thermotherapy. In the absence of effect or the big size of a tumor of a horioidea the enukleation is shown.
Tumors of a horioidea are good-quality or malignant new growths of a vascular cover of an eyeball. A nevus – the most widespread good-quality formation of an organ of vision. Frequency of its identification at an oftalmoskopiya makes 2%. In too time, at autopsy this pathology is diagnosed for 6,5-20% of patients. At persons women's and a male nevus is defined equally. Prevalence of a uvealny melanoma among all pathologies of eyes makes 5%. The risk of formation of this tumor of a horioidea significantly increases the patient with age and after 69 years increases on 50 cases every year (at the rate on 1 million population). The general incidence gemangiomy eyes among total number of intraorbital pathological new growths makes 0,76%. This type of a tumor of a horioidea meets in all age groups, but to a thicket is diagnosed after 10 and up to 60 years.
Reasons of tumors of a horioidea
Often tumors of a horioidea develop sporadic. However in literature family cases of a uvealny melanoma are described that allows to carry it to number of genetically determined pathologies. Dysfunction of genes-supressorov of the tumoral growth (CDKN2A, CDK4) leads to development of the chromosomal mutations which are localized on a short shoulder 21 or a long shoulder of the 14th chromosome. The cascade of pathological processes includes violation of synthesis of proteins of p16 and p14ARF. Can precede development of this tumor of a horioidea okulodermalny or violation of pigmentary exchange. Quite often it results from a malignization of the progressing nevus, but the most common cause of emergence of a neoplasia – a mutation of "de novo". Taking into account a morphological picture distinguish the veretenokletochny, epitelioidny and mixed options of a uvealny melanoma. Specific coloring of a tumor of a horioidea is caused by adjournment of lipofustsinovy grains.
Gemangioma is among gamarty. The education reason – fabric anomaly of development. The structure of a new growth has the same components, as surrounding fabrics, but extent of its differentiation and a structure are sharply broken. The risk of development of tumors of a horioidea increases at long contact with ultra-violet radiation or against the background of solar burns of eyes. In population the disease meets more often among persons at whose phenotype there are blue eyes, light skin and hair, a multiple nevus (more than 50).
Symptoms of tumors of a horioidea
From the clinical point of view allocate vascular and pigmentary tumors of a horioidea. Also distinguish good-quality and malignant new growths. Carry a nevus to pigmentary forms (stationary and progressing). In most cases it is a congenital type of tumors of a horioidea, but intensity of pigmentary coloring amplifies after 30-year age. They are revealed in a back pole of an eyeball, is more rare in the equatorial area or before it. Cases of binocular damage of an organ of vision are described. As a rule, course of a disease asymptomatic. Increase at a rate of the progressing nevus in rare instances leads to decrease in visual acuity.
Clinical displays of a uvealny melanoma depend on its diameter and extent of involvement in pathological process of surrounding vessels. Angiogenesis in the field of a tumor of a horioidea and change of a vascular wall (a thickening and consolidation) is led to a rupture of an internal cover of an eyeball. Often the symptomatology is absent. In rare instances patients show complaints to light flashes, decrease in visual functions, emergence of "front sights" or "a black curtain" before eyes. At big prevalence of tumoral process at patients visual acuity progressively decreases.
Gemangioma treats group of benign tumors of a horioidea. The fast-progressing growth which very often leads to a full otsloyka of a retina is characteristic of it. The first symptom of a disease at adults – violation of visual functions. At children's age this tumor of a horioidea becomes the strabizm reason. From the clinical point of view allocate limited and diffusion forms. At limited option the small knot with accurately outlined edges is formed. Clinical manifestations are a little expressed. At diffusion distribution of tumoral process, the disease is complicated by an entsefalofatsialny angiomatoz (Sterdzha-Weber's syndrome).
Diagnosis of tumors of a horioidea
Diagnosis of tumors of a horioidea is based on results of an oftalmoskopiya, vizometriya, fluorescent angiography, biomicroscopy, the optical coherent tomography (OCT), ultrasonography (BRIDLES) in the V-mode. At an oftalmoskopiya a nevus has an appearance of the flat, raised over level surrounding fabrics of educations up to 0,1 cm in size. Depending on expressiveness of pigmentation their color varies from grayish to gray-brown. Borders often uneven, but with accurate outlines. Roughness of contours is caused by adjacent vessels. Oval or rounded shape with the equal, but less outlined contours is characteristic of the nevus deprived of a pigment. Unlike the progressing nevus, at a surface of stationary there are Druzes. For their differential diagnostics the oftalmoskopiya with color filters is carried out. Red coloring of the filter allows to visualize this type of a tumor of a horioidea, at green pathological education is not defined.
By method of a fluorescent angiography at a stationary form decrease in fluorescence throughout all inspection comes to light. At the same time in a surrounding vascular cover of change do not come to light. Changes of a horioidea are demonstrated by a propotevaniye and a bright luminescence of dye. At an oftalmoskopiya of a uvealny melanoma the small small knot with the post-equatorial localization is found. A horioidea tumor – yellowy-brown or flaky coloring with Druzes on a surface or in surrounding fabrics. Exact localization, the sizes, extent of distribution on surrounding fabrics is established by the OCT method. For the majority the patient at a vizometriya diagnoses decrease in visual acuity.
When carrying out an oftalmoskopiya the delimited gemangioma has an appearance of a small small knot of rounded shape with equal contours with a diameter of 0,3-1,5 cm. Average thickness of pathological education makes 0,3-0,4 cm. Color of this form of a tumor of a horioidea – from light gray to dark red. For differential diagnostics of a gemangioma from a melanoma it is necessary to carry out a fluorescent angiography. At a gemangioma the average diameter of vessels of a tumor corresponds to that of horioidea vessels, also on its surface the small centers of hemorrhage can appear. Because of the progressing angiogenesis at a melanoma neogenic capillaries have smaller caliber and more wavy the course. On BRIDLES of a tumor of a horioidea current of blood and a characteristic pulsation of vessels is defined that allows to confirm the diagnosis. External examination is performed for identification of typical symptomatology of a strabizm.
Treatment of tumors of a horioidea
Treatment tactics at tumors of a horioidea depends on a disease form. At emergence of the signs demonstrating transformation of a stationary nevus in progressing laser coagulation is shown. At detection of a uvealny melanoma of the big size it is necessary to carry out an eyeball enukleation. If diameter of a pathological new growth insignificant, and a tumor does not extend out of limits of primary center, contact radiation therapy (eye brachytherapy) is recommended. Advantage of this method of treatment of tumors of a horioidea – local impact on a melanoma the maximum dose of radiation therapy. At the same time radiation does not influence surrounding fabrics and critical bodies. Alternative option – transpupillyarny the diode - laser thermotherapy. This method is among low-invasive the technician. At the same time all procedure is carried out under visual control.
Identification of a gemangioma is an indication to performing surgery that is caused by big risk of an ekssudativny otsloyka of a retina and decrease in visual functions. In treatment of the delimited form of a tumor of a horioidea cryotherapy, brachytherapy, photodynamic therapy and transpupillyarny the diode - laser thermotherapy is used. High efficiency the lazerokoagulyation in a yellow range of radiation has. Tactics of treatment comes down to an obliteration of blood vessels. Advantage of this technique – elimination of an exudate of exudate from neogenic vessels due to adhesion of a pigmentary layer and a touch retina. Subretinalny liquid at the same time rezorbirutsya.
Forecast and prevention of tumors of a horioidea
Specific measures for prevention of tumors of a horioidea in ophthalmology it is not developed. All patients with the established diagnosis of a good-quality or malignant new growth of a vascular cover have to be on the dispensary account at the ophthalmologist. After performing expeditious treatment it is periodically necessary to undergo preventive inspection at the expert, to limit stay in the sun, to avoid work at high temperature of the environment.
The forecast for life and working capacity at a stationary form of a nevus favorable. The progressing option should be considered as a precancer state. The most malignant among horioidea tumors – a melanoma, the forecast for life is defined by a development stage. Gemangioma of a vascular cover – predictively a favorable disease, however at certain patients is possible total loss of sight.