玻璃体手术治疗Coats病的效果观察

Vitrectomy for severe Coats′ disease

目的 探讨玻璃体手术治疗伴有广泛渗出性视网膜脱离的Coats病患者的疗效 ,并观察其预后。方法 1995年 12月至 1999年 12月 ,对 11例 (11只眼 )伴有严重渗出性视网膜脱离或显著视网膜前增殖的Coats病患者进行玻璃体手术治疗。随访时间 3个月至 4 5年。 11例中除 1例为黄斑前纤维增殖牵引性视网膜脱离外 ,余均为视网膜全脱离 ;其中 4例尚伴有广泛的视网膜前增殖和牵引。结果 11例患者中除 1例终止手术外 ,余均获得有用视力 ,其中 3只眼视力优于 0 0 2 ,最佳视力0 2。 10例视网膜复位满意 ,1例终止手术失访。术后随访有 4例视网膜脱离复发 ,经治疗后视网膜均重新复位 ,玻璃体手术的成功率为 90 9%。结论 对视功能严重受损的Coats病患者 ,行玻璃体手术结合眼内光凝或巩膜外冷凝可使视网膜复位 ,促进渗出性病变退缩 ,有效保持有限的视功能 。

Objective To investigate the outcome of vitreoretinal surgery for severe Coats′ disease Methods From December 1995 to December 1999, trans pars plana vitrectomy was performed in 11 patients (11 eyes) diagnosed as Coats′ disease Ten of them were complicated with total retinal detachment, and the other one had tractional retinal detachment caused by epiretinal proliferation All these patients were followed up from 3 months to 4 5 years Results All of the patients obtained useful vision except 1 patient whose operation was given up because of severe shortening of the retina Three patients had the visual acuity higher than 0 02, and the best vision was 0 2 Obliteration of all abnormal vessels and resorption of all exudate was found postoperatively from 1 month to 3 months Although the retina had been reattached in 10 patients during the operation, re detachment was found in 4 patients postoperatively After therapy all re detached retina was reattached The success rate was 90 9% Conclusions Vitrectomy with endolaser or scleral cryotherapy is an ideal therapy for severe Coats′ disease, although the visual prognosis is still limited It can preserve the limited vision, and prevent the severe complications such as rubeosis iridis, glaucoma, and phthisis bulbi