经巩膜视网膜下液引流及冷凝术联合康柏西普治疗3期外层渗出性视网膜病变疗效观察

目的 研究经巩膜视网膜下液引流及冷凝术联合玻璃体腔注射抗血管内皮生长因子(VEGF)对3期Coats病的疗效。方法 回顾性分析1l例(11眼) 3期Coats病的临床资料,患者年龄2-16岁；其中男性10例,女性1例；3A期Coats有7眼(部分视网膜脱离),3B期Coats有4眼(完全视网膜脱离)。所有患眼接受经巩膜视网膜下液引流及视网膜异常血管冷凝术,联合玻璃体注射抗VEGF药物。主要疗效指标为最佳矫正视力,眼压,视网膜复位情况。结果 术后患者随访6-20个月,平均随访11 ± 3月。随访结束时11例患者中,视力提高8例,视力无变化1例,视力下降1例,视力检查不配合1例；3A期患者术后视力(1.10±0.50)较术前视力(1.81±0.95)提高,差别有统计学意义(p=0.0196, N=7)。新发生斜视1例(患者年龄小视力差)；9例视网膜达到完全复位,2例仍有局限视网膜脱离,随访中未发生其他并发症。结论 经巩膜视网膜下液引流及冷凝术联合玻璃体腔注射抗VEGF药物是一种有效治疗3期Coats病的方法,患者视网膜复位率高,能有效挽救视功能。

Efficacy of transscleral subretinal fluid drainage and cryotherapy combined with conberceptin treatment for stage 3 Coats disease

Objective To investigate the efficacy of transscleral drainage of extensive sub-retinal fluid and cryotherapy with intravitreal injection of anti-vascular endothelial growth factor (VEGF) in management of stage 3 Coats disease. Methods A retrospective consecutive case study. There were 11 patients (11 eyes) diagnosed Coats disease (stage 3), including 10 boys and 1 girl, aged 2-16 years old; 7 eyes with partial retinal detachment (stage 3a) and 4 eyes with complete retinal detachment (stage 3b). All eyes were treated with subretinal fluid drainage via sclera, followed by retinal cryotherapy and intravitreal injection of anti-VEGF drug. Best Corrected Visual acuity, intraocular pressure and retinal attachment were recorded. Results The patients were followed up for 6-20 months with an average of (11 ± 3) months. At the end of follow-up, in 11 cases, visual acuity improved in 8 eyes, visual acuity unchanged in 1 eye, visual acuity decreased in 1 eye, 1 case could not cooperate with the examination. Postoperative visual acuity (1.10±0.50) was improved compared with preoperative visual acuity (1.81±0.95) (P =0.0196, N=7). The retina was completely reattached in 9 eyes and localized retinal detachment in 2 eyes. Strabismus occurred newly in one eye. No serious complications were found. Conclusion Transscleral subretinal fluid drainage, cryotherapy combined with intravitreal injection of anti-VEGF is an effective method for the treatment of stage 3 Coats disease, which can make the retina of most patients reset and rescue the visual function effectively.