Coats病治疗的临床观察

The Clinical Observation of the Treatment with Coats

目的观察Coats病的临床治疗效果。方法回顾分析安阳市眼科医院治疗的15例(15只眼)Coats病患者的临床资料,男性14例14只眼,女性1例1只眼,均单眼发病,年龄7～46岁,平均20.0岁,所有患者治疗前后进行视力、眼底及眼底荧光造影检查(FFA)。依据Shields所述分期标准,将15只眼进行分期。1期1只眼占0.5%;2期12只眼占80.0%;3期2只眼占13.3%,其中1、2期13只眼接受视网膜激光治疗,激光治疗2次者1只眼,2次以上者13只眼,激光治疗间隔时间1.5～3个月。3期2只眼行激光联合巩膜外冷凝治疗。结果治疗后随访6～36个月,平均18个月。1、2期Coats病行视网膜激光治疗13只眼,治疗后视力提高明显,恢复2行以上,末次视网膜激光治疗后3个月行FFA检查:渗漏停止,渗出吸收。激光联合巩膜外冷凝治疗的2只3期Coats病眼最终视网膜脱离复位,病情控制,但视力无提高。结论 Coats病多发于男性,各年龄段均可发病,多单眼发病,最本质特征是微血管异常扩张,伴有黄白色脂质渗出,严重者视网膜脱离,对视力损害严重,早期诊断及时治疗至关重要。

Objective To observe the clinical effects of the treatment with Coats.Methods A clinical data of 15 cases was analyzed,including 14 male patients（14 eyes） and 1 female patient（1 eye）,monocular involvement happened in all the 15 patients.The mean patient age was 20.0（range,7 to 46） years.All patients underwent vision、fundoscopy and FFA examination before and after the treatment.According to the standard builded by Shields,the 15 eyes were divided to three periods.The first period included 1 eye（0.5%）;the second period included 12 eyes（80%）;the third period included 2 eyes （13.3%）.13 eyes,belonged to the first and the second period,received retinal photocoagulation.One eye received twice therapy,13 eyes received twice and more.The interval time of photocoagulation was 1.5 to 3 months.The two eyes of the third period received the treatment of combined photocoagulation with transcleral cryotherapy.Results The follow-up was 6 to 36 months,mean 18 months.The visions of the first and second period patients improved obviously,2 lines or more.The FFA,was done after the last retinal photocoagulation 3 months,showed that the leakage was disappeared and the exudation was absorbed.The retinal detachment of the 2 eyes in the third period,that received the treatment of combined photocoagulation with transcleral cryotherapy,reattached finally,but the visual acuity had no improved.Conclusion Coats is not a common disease,in any aged,mostly monocular involvement.The most essential characteristic is capillary abnormal ectasias with yellowish-white lipid exudation,even retinal detachment,resulting in severe vision loss,so the early diagnosis and treatment are very important.