抗VEGF药物联合激光治疗成人型Coats病的临床分析

Clinical analysis of intravitreal injection of Conbercept combined with 532-laser treating Coats disease in adulthood

目的:探讨18岁以上成年型Coats病的临床特点及抗VEGF药物联合激光治疗的有效性及安全性。方法:回顾性分析我院眼科2015-01/2016-06期间经荧光素眼底血管造影(FFA)及光学相干断层扫描(optical coherence tomography,OCT)检查确诊的成人型Coats病患者6例6眼。采用糖尿病视网膜病变早期治疗研究视力表(ETDRS)检查最佳矫正视力(BCVA),OCT检查测量黄斑中心厚度(CMT)。患眼平均BCVA为51.17±15.15个字母;CRT为221~673(平均303.30±107.87)μm。所有患眼玻璃体腔注射10mg/mL康柏西普0.05mL(含康柏西普0.5mg),1wk后给予532nm激光光凝病变视网膜组织,平均随访时间7.33±1.26mo。仔细阅读FFA检查图像,分析成人型Coats病的临床特点,对比分析治疗前后患眼BCVA的变化,同时观察随访期间眼部与全身不良反应的发生情况。结果:治疗后1wk,1、3mo及末次随访时,患眼平均BCVA均较治疗前提高,差异均有统计学意义(均P<0.01)。治疗后1mo平均BCVA提高的字母数与末次随访相比,差异有统计学意义(P<0.01),末次随访时,显著提高3眼(50%),提高2眼(40%),稳定1眼(10%);治疗后患眼视网膜下液均有不同程度减少,随访期间均未见与治疗相关的严重眼部及全身并发症。结论:成人型Coats病视网膜血管异常扩张范围局限,进展缓慢,治疗预后好,抗VEGF联合激光治疗能够提高患眼视力,减少视网膜积液,安全性好。

AIM. To analyze clinical observation and the efficiency of intravitreal conbercept combined with 532- laser on Coats disease in adulthood. METHODS： This was an retrospective analysis. Six eyes from 6 patients（5 males and 1 female） with coats disease diagnosed by fundus fluorescein angiography （FFA） and optical coherence tomography （OCT） were enrolled. Before the injection, best-corrected visual acuity （BCVA） of early treatment of diabetic retinopathy study （ ETDRS）, non - contact tonometer, ophthalmoscope, fundus photography, FFA, and OCT were examined. The initial average visual acuity （ETDRS letters） were 51.17±15.15. The initial average central retina thickness （CRT） was 303.30±107. 87μm. All affected eyes were treated with intravitreal conbercept 0. 05mL （10mg/mL） combined with 532-laser. Patients were followed up for 6 to 12mo, with a mean duration of 7.33±1.26mo. Post-treatment BCVA were compared with baseline using repeat analysis. ~ RESULTS： The mean BCVA showed significant improvement during 1 wk, 1,3mo post-treatment and the latest follow up （ P〈0.01 ）. During the latest follow up, the mean BCVA was obviously improved in 3 eyes （50%）, improved in 2 eyes （40%）, stable in 1 eyes （10%）. Likewise, the subretina fluid absorption of different levels. No adverse events such as secondary retinal detachment or endophthalmitis were found during the follow-up. CONCLUSION： Coats disease in adulthood more likely to have lower symptom and have a better response on treatment. Intravitreal conbercept combined with 532- laser significantly improve visual acuity and absorb the subretina fluid.