成人Coats病1例

目的：报告成人Coats病1例,并探讨其引起的视网膜病变。方法：病例报告。结果：马来西亚63岁糖尿病患者1例,男,右眼无痛性视力下降1a,视力指数/2英尺,而左眼最佳矫正视力为6/12。右眼眼底表明颞侧后极部出现广泛的视网膜渗出物,可累及黄斑区和鼻侧视盘。异常分布的多区域血管位于黄斑颞侧且呈衰减趋势。眼底荧光血管造影显示,毛细血管扩张在视网膜渗出区域且有荧光素渗漏现象存在。左眼表现正常。根据临床和FFA结果,患者被诊断为成人Coats病,右眼行氩激光光凝治疗。激光后6mo,患者的视力保持在6/120并出现视网膜最小限度的回退。结论：临床和血管造影结果是视网膜毛细血管扩张症的重要诊断依据。渗漏区域激光光凝治疗有利于防止视力丧失。     

Coats病误诊1例

患者女 42岁因发现左眼视力下降1月于2000年4月2日入院.全身检查未见异常.眼部检查:视力:右眼1.2,左眼手动/15cm.     

成人Coats病一例

患者男,64岁.因左眼渐进性视物不清1年于2012年3月19日来我院就诊.既往体健.家族中无类似疾病者.眼部检查:右眼视力0.8,矫正1.0;左眼视力0.04,不能矫正.裂隙灯显微镜检查双眼眼前节未见异常.直接检眼镜眼底检查结果显示,左眼视盘颜色正常,边界清晰,黄斑部可见环形硬性渗出和水肿,拱环下半毛细血管异常扩张,黄斑中心凹正下方0.5、3.5个视盘直径(DD)处分别可见小动脉瘤样扩张(图1,2);视盘颞上方视网膜下黄白色不规则隆起渗出,约2.0 DD大小,高达2个屈光度,其上及视盘正上方周边部视网膜小血管不规则局部扩张,并可见出血和红色动脉瘤样病灶,部分血管闭塞(图3);其它部位视网膜未见明显异常.右眼眼底未见异常.荧光素眼底血管造影检查结果显示,静脉早期病灶区视网膜毛细血管扩张,不同大小血管瘤呈强荧光,出血及硬性渗出遮蔽荧光;周边部可见约4.0 DD大小毛细血管无灌注区;晚期瘤体及异常血管荧光渗漏着染.视盘颞上方病灶区大片强荧光渗漏(图4～6),黄斑区弥漫性水肿.实验室检查,血胆固醇正常.临床诊断:成人Coats病.建议行激光光凝治疗,但因患者依从性差而未执行.     

双眼Coats病一例

患者，女，11岁，因右眼视力下降半年，于2001年2月21日来我院就诊，否认早产及吸氧史。检查：视力右眼眼前手动，左眼L2，双眼眼前节未见异常，右眼玻璃体轻度混浊，颞侧视网腹球形降起，视网膜下大量黄白色渗出和胆固醇样结晶（图1）。     

Coats病的诊断与治疗

Coats病即外层渗出性视网膜病变,于1908年由George Coats首先描述,它是以视网膜毛细血管扩张,视网膜内黄白色渗出以及渗出性视网膜脱离为特点的眼底病。本病须与视网膜母细胞瘤（retinoblastoma,RB）鉴别。过去,我院病理科几乎每年都会有将Coats病误诊为RB而作眼球摘除的病例,但近20多年来,无一例错摘事件发生,这应归功于我们对Coats病与RB认识的加深和影像诊断学的发展。     

儿童Coats病误诊二例

大块渗出性视网膜病又称Coats病,是一种少见疾病,我们遇到2例被误诊的Coats病患者,现报告如下。例1女2岁因家长发现其右眼瞳孔发白而于1997年8月来我院就诊,查体:右眼视力无光感,结膜无充血,角膜透明,角膜后无沉着物,前房浅,瞳孔6mm,圆形,直     

Coats病16例疗效观察

目的 探讨Coats病的治疗方法.方法 对Coats病患者16例16只眼,按照Schieds分期的不同,而分别采取激光、冷凝或玻璃体手术治疗.结果 2期患者2例2只眼经视网膜光凝治愈;3期或4期患者11例11只眼行玻璃体手术,8例视网膜复位;3期患者3例3只眼行冷凝联合激光术,视网膜均复位.结论 Coats病的治疗需个体化方案.对视功能严重受损的Coats病患者,行玻璃体手术可使视网膜复位,促进渗出性病变退缩,保持有限的视功能,避免并发症的发生;视网膜冷凝术对于Coats病的治疗仍有一定意义.     

205例Coats病临床分析

目的分析总结Coats病患者的一般临床规律和眼底特征。方法回顾分析205例Coats病患者211只眼的临床资料，统计分析患者性别、年龄、眼别及视力分布情况；根据检眼镜以及荧光素眼底血管造影(FFA)检查所见的眼底及FFA特征，分析病变部位、范围及病变程度，探究病变分布及发展规律。结果 205例患者就诊时平均年龄28.0岁，20岁以上占54.2%。其中，男性占76.1%；单眼发病占97.1%。211眼中，视力0.3及其以下者占67.3%。所有患者均有眼底微血管异常扩张，90.5%伴有黄白色脂质渗出；异常扩张血管90.1%位于颞侧，73.9%位于赤道以前，72.5%波及1个以上象限。结论 Coats病多发于男性，各年龄段均可发病，几乎均为单眼发病。最本质特征是微血管异常扩张，绝大部分位于颞侧赤道前的视网膜，通常伴有黄白色脂质渗出并波及黄斑，对视功能损害严重。 （中华眼底病杂志，2008，24：276-278）     

双眼Coats病的临床观察

目的：探讨双眼Ｃｏａｔｓ病的临床特点和发病情况。方法：对７例双眼Ｃｏａｔｓ病患者进行临床观察及治疗。结果Ｃｏａｔｓ病双眼发病较少，双眼病变多不平衡，病变较轻眼可不典型，位于颞侧周边，常无症状，可缓慢进展，对Ｃｏａｔｓ病患者检查双眼底和全身关联疾病为必要。     

Manifestation of Coats' disease by age in Taiwan

BACKGROUND: To compare the differences in clinical manifestation of Coats' disease between younger and older patients in the Far East. METHODS: Coats' disease cases diagnosed at one Taiwanese hospital from July 1986 to June 2004 were retrospectively reviewed (n=30; 32 eyes). Patients were stratified into groups according to the initial diagnosis of Coats' disease at the age of <20 years (Group Y) or >or=20 years (Group O). The clinical manifestations of Coats' disease in Group Y (19 eyes) and Group O (13 eyes) were compared. RESULTS: A higher proportion of female patients was noted in Group O (P=0.046). Diseases were generally limited geographically, with 14 eyes (73.7%) manifesting involvement greater than 6 clock hours in Group Y and four eyes (30.8%) in Group O. The involved area including retinal telangiectasia and exudates was smaller in Group O (P=0.016). Patients without posterior pole involvement were associated with better visual outcome (adjusted odds ratio, 6.5; 95% confidence interval, 1.1-40.1, P=0.044). CONCLUSION: Coats' disease manifestation was different between different age groups. Treatment is important to prevent disease progression. Visual prognosis is associated with posterior pole involvement.     

Subfoveal nodule in Coats' disease

An atypical presentation of Coats' disease is reported with a prominent subfoveal nodule with peripheral retinal exudates. A 6-year old boy presented with 6/120 vision in the left eye associated with an elevated 1 mm subfoveal, circular lesion with peripheral exudates. The fluorescein angiogram showed peripheral retinal telangiectasias with leakage consistent with Coats' disease. The prominent subfoveal nodule is an uncommon initial presentation of Coats' disease and physicians should be aware of this atypical finding.     

Coats' disease. Evaluation of management

Forty-one patients representing 43 eyes with retinal telangiectasia and subretinal exudates (Coats' Disease) were managed between 1966 and 1980. Thirty-three eyes in 31 patients between 4 and 45 years of age had an average of two quadrants involved with telangiectasia. Of four untreated eyes, three deteriorated and one stabilized. In contrast, of 29 eyes treated with cryotherapy or photocoagulation, eight deteriorated, 15 stabilized, and six improved. Ten patients in the series were under 4 years of age and had more severe disease than older patients. On the average three quadrants were involved with telangiectasia and subretinal exudate. Three untreated eyes rapidly progressed to total retinal detachment with glaucoma. The seven treated children required frequent assessment and repeated treatment. Of these, one stabilized but had no light perception, and the remaining six improved. The authors stress that the disease can be controlled with aggressive treatment. Their treatment methods are described.     

Retinoblastoma in a young adult mimicking Coats’ disease

Retinoblastoma is the most common childhood primary intraocular malignancy, with the majority of cases being diagnosed before 5 years of age. Retinoblastoma in adults is extremely rare. Here, we report the case of a 20-year-old man who presented with a 3 year history of blurred vision in the right eye. Imaging did not reveal the typical presentation of retinoblastoma. After considering Coats’ disease, a diagnosis of late-presenting retinoblastoma was made through cytological analysis. Diagnosis of retinoblastoma should be considered in the presence of uncertain mass lesions in the fundus of an adult.     

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

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200~260 mw;视网膜脱离处使用黄光光凝,能量100~150 mw;血管异常处使用黄光光凝,能量220~240 mw。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。     

Bilateral Coats' disease with unusual presentation--a case report

Coats' disease is a well-known ocular disorder, characterized by idiopathic retinal telangiectasia, retinal exudation and retinal detachment. We report on a boy who first presented at the age of 2 years with Coats' disease and secondary neovascular glaucoma. The differential diagnosis with retinoblastoma could not be made clinically or with the help of imaging studies, such as ultrasonography or computed tomography scanning (CT-scan). The right eye was consequently enucleated for diagnostic and therapeutical purposes. Histopathologic examination confirmed the diagnosis of Coats' disease. Five years later the same boy consulted again with profound visual loss in his only functional left eye. Fundoscopy revealed lesions typical for Coats' disease. Coats' disease can present in very different ways and bilateral disease is possible, even after several years.     

Combined photodynamic therapy and intravitreal bevacizumab injection for the treatment of adult Coats' disease: a case report

A 68-year-old woman presented with a visual field defect in her right eye. The fundus of her right eye showed multiple telangiectatic vessels, retinal hemorrhages, and subretinal exudates in the inferior peripheral retina. Nine months later, the subretinal exudates extended to the fovea despite treatment with laser photocoagulation. Cryotherapy was not possible at the time because of the posterior location of the retinal telangiectatic vessels. She was treated with a combination of photodynamic therapy (PDT) and intravitreal bevacizumab injection: three injections were given at 2-month intervals. After this combined therapy, her right fundus revealed a significant regression of abnormal retinal vessels and subretinal exudates. A fluorescein angiography showed no leakage from the abnormal retinal vessels. At 9 months after the combined therapy, she was able to maintain a stable visual acuity and visual field. This is the first case report that demonstrates the efficacy of the combined treatment of PDT and intravitreal bevacizumab injection in Coats's disease. This combined therapy is a kind of treatment modality for adult Coats' disease in cases which cryotherapy cannot be employed and are refractory to laser photocoagulation.     

视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病的初步观察

目的 观察视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病的疗效.方法 前瞻性连续病例研究.21例伴有渗出性视网膜脱离的Coats病患者的21只眼纳入研究,其中,男性19例,女性2例,年龄2～18岁;部分视网膜脱离15只眼,属3A期,完全视网膜脱离6只眼,属3B期.所有患眼均接受视网膜冷冻手术联合玻璃体注射曲安奈德治疗,3只眼辅助巩膜切开引流视网膜下液.经视网膜冷冻手术联合玻璃体注射曲安奈德治疗后,4只眼针对残余异常血管再行视网膜光凝或冷冻手术.治疗后随访3～15个月,平均随访时间(7±3)个月.观察视力、眼压、眼位及眼球运动、裂隙灯、间接检眼镜及彩色眼底像,比较异常血管变化,视网膜下液及渗出的吸收情况等.以末次随访为疗效判定时间点.结果 治疗后眼压增高6只眼,均局部药物控制.随访结束时,视网膜复位19只眼,局限视网膜脱离1只眼,视网膜全脱离1只眼.视力提高3只眼,不变14只眼,下降2只眼.新发生斜视1只眼.新发生白内障或白内障加重4只眼.结论 视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病,可使大部分患者视网膜复位,视功能可以有效保存.