多波长激光治疗伴有视网膜脱离的Ⅲ期青少年型Coats病初步观察

Multiple wave length laser-a new therapy for juvenile Coats' disease with mild or moderate retinal detachment

目的观察多波长激光治疗伴有轻中度视网膜脱离的Ⅲ期青少年型Coats病的疗效。设计回顾性病例系列。研究对象伴有轻中度视网膜脱离的青少年型Coats病（Shields等分期标准3A期）8例8眼，全部患者视网膜血管均异常扩张和存在散在的粟粒状动脉瘤样改变，周围可见无灌注区；其中交通支形成3眼；病变位于赤道部附近7眼。黄斑部均有黄色渗出，外斜视4眼，内斜视1眼。方法采取在视网膜脱离交界处使用包围式绿光光凝，Ⅲ级光斑，能量200—260mw；视网膜脱离处使用黄光光凝，能量100～150mw；血管异常处使用黄光光凝，能量220～240mw。重复治疗间隔2个月，光凝3-8次。主要指标视力及视网膜脱离复位情况。结果视网膜脱离完全复位4／8眼（50％），脱离范围明显缩小3／8眼（38％），无明显变化1／8眼（13％）；视网膜微血管瘤和无灌注区消失5／8眼（63％），大部分消退2／8眼（25％），无明显变化1／8眼（13％）；黄斑部渗出明显吸收7／8眼（88％），无明显变化1／8眼（13％）。视力提高6／8眼（75％），无变化2／8眼（25％），无视力下降者。结论本文的小样本资料表明，多波长激光光凝治疗伴有轻中度视网膜脱离的青少年型Coats病有效，无明显视网膜前增殖，能最大限度地保存视力。

Objective To obsevrive the treatment effect of multiple wave length laser on juvenile Coats＇ disease with mild or moderate retinal detachment. Design Retrospective case series. Participants 8 patients（8 eyes） were diagnosed as Coats＇ disease with different extent detachment of retina （Shields＇ stage IIIA）. All eyes had expansion retinal vascular, microangioma, and nonperfusion field. 3 eyes bad communicating branch. Methods Green laser was used in the borderline of detached retina with energy 200-260 raw. Yellow laser, energy of which was 100-150 mw, was used in the field of detached retina, then the yellow energy with 220-260 mw energy was used in abnormal vascular field. Retreatment was carried out two month later. 3-8 times photo-coagulation treatments were performed. Main Outcome Measures The visual acuity and the anatomic reposition of retinal detachments. Results After photu-coagulation treatments, the improvement of final visual acuity was in 6 patients （75%）, unehange in 2 patients （25%）. Four patients （50%） with exudative retinal detachments achieved anatomic suecess, and the telangiectasis were completely dissapeared. 3 patients（38%） with retinal detachments achieved partial anatomic： reposition, but the area of retinal detachment decreased significantly compared with that before treatment, so did the telangiectasis. Macula exudation was absorbed in 7 eyes （88%）, and one eye was no change. Conclusion The multiple wave length laser photoeoagulation may provide a new alternative on treating juvenile Coats＇ disease and will be helpful to maintain useful vision.