间接检眼镜532 nm激光联合雷珠单抗治疗2期及以上小儿Coats病

Pediatric Coats disease of stage 2 and greater managed with 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab

目的观察间接检眼镜下532 nm波长激光联合玻璃体腔注射雷珠单抗(IVR)治疗2期及以上小儿Coats病的疗效。方法回顾性、非对照临床研究。2018年2月至2020年8月于北京同仁医院眼科中心检查确诊的2期及以上Coats病患者21例21只眼纳入研究。其中,男性20例,女性1例;年龄(5.00±1.92)岁。2A、2B、3A、3B、4期分别为2、8、7、2、2只眼。患眼均行广角眼底彩色照相、荧光素眼底血管造影(FFA)检查。行最佳矫正视力(BCVA)检查17只眼。眼底均可见异常扩张的视网膜血管,视网膜层间及视网膜下渗出;FFA检查可见视网膜异常扩张的毛细血管及瘤样扩张血管。患眼均行间接检眼镜下532 nm波长激光光凝联合IVR治疗。3B期及以上患眼严重视网膜脱离者先行视网膜下液(SRF)外引流,其后治疗同前。治疗后随访时间(35.67±6.13)个月。采用治疗前相同设备和方法行相关检查。观察治疗次数、视力变化、解剖预后以及并发症发生情况。结果患眼光凝次数(2.43±0.98)次;IVR治疗次数(2.00±0.89)次。首次治疗联合SRF外引流3只眼。末次随访时,行BCVA检查的17只眼中,视力提高、无变化、下降分别为5、11、1只眼。21只眼中,视网膜在位17只眼;合并视网膜囊肿5只眼。随访期间,发生白内障及玻璃体增生牵拉1只眼,行玻璃体切割手术治疗;发生轻度玻璃体增生1只眼。结论间接检眼镜下532 nm激光联合IVR是治疗2期及以上小儿Coats病的有效治疗手段。

Objective To investigate the efficacy of 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab(IVR)in treating stage 2 and greater pediatric Coats disease.Methods A retrospective,non-controlled clinical study.From February 2018 to August 2020,21 eyes of 21 patients with Coats disease stage 2 and greater diagnosed by examination in the Eye Center of Beijing Tongren Hospital were included in the study.Among them,20 patients were males;1 patient was female.Mean age was 5.00±1.92 years old.Stage 2A,2B,3A,3B,and 4 were 2,8,7,2,and 2 eyes,respectively.All eyes underwent wide-field fundus color photography and fluorescein fundus angiography(FFA).Best corrected visual acuity(BCVA)was performed in 17 eyes.Abnormal dilated retinal blood vessels,interretinal and subretinal exudates were found in all eyes.Abnormally dilated capillaries and aneurysms in the retina was shown in FFA examination.All eyes underwent 532 nm laser photocoagulation using indirect ophthalmoscope combined with IVR.Patients with severe retinal detachment of stage 3B or greater were treated by external drainage of subretinal fluid(SRF).The subsequent treatment was the same as before.The follow-up time was 35.67±6.13 months.Relevant examinations were performed using the same equipment and methods before.The frequency of treatment,visual acuity changes,anatomic prognosis,and complications were observed.Results The frequency of eye photocoagulation was 2.43±0.98.The number of IVR treatments was 2.00±0.89.Three eyes were treated with SRF drainage in the first time.At the last follow-up,visual acuity improved,no change,and decreased in 5,11,and 1 eyes after BCVA examination,respectively.In 21 eyes,the retina was in situ in 17 eyes;5 eyes with retinal cysts.During the follow-up,cataract and vitreous hyperplasia occurred in 1 eye,which was treated by vitrectomy,and mild vitreous hyperplasia occurred in 1 eye.Conclusion Indirect ophthalmoscope 532 nm wavelength laser combined with IVR is an effective treatment for pediatric Coats disease.