玻璃体腔注射抗血管内皮生长因子药物联合其他方法治疗晚期Coats病的疗效观察  

Outcomes of adjuvant intravitreal anti-vascular endothelial growth factor therapy in advanced Coats disease

作　　者：陈欢[1] 陈有信[1] 韩若安[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼底病杂志》2015年第3期252-255,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察玻璃体腔注射抗血管内皮生长因子（VEGF）药物联合其他方法治疗晚期Coats病的临床疗效.方法 回顾性病例系列研究.经眼底和荧光素眼底血管造影（FFA）检查确诊为晚期Coats病的14例患者14只眼纳入研究.其中,3B期8只眼,4期6只眼.所有患眼行视力、眼压、间接检眼镜、裂隙灯显微镜、FFA、眼部B型超声检查.14只眼中,视力无光感3只眼,光感4只眼,手动3只眼,数指2只眼,因患儿年幼无法配合检查2只眼.所有患眼均可见异常扩张视网膜血管及视网膜下大量胆固醇样结晶及渗出,伴全视网膜脱离.所有患眼均行玻璃体腔注射贝伐单抗或雷珠单抗治疗,注射次数为1～7次,平均注射次数2.14次.14只眼中,联合单纯巩膜外放液4只眼,联合单纯激光光凝治疗2只眼,联合玻璃体切割、剥膜、冷冻、激光光凝、硅油填充等治疗8只眼.治疗后随访时间4～36个月,平均随访时间18.8个月.随访期间采用与治疗前相同的检查设备和方法行相关检查,观察患眼视力及视网膜复位情况.结果 随访期间,无1例患者因病情进展而行眼球摘除手术,眼球保留率100.0％.14只眼中,视力提高2只眼,视力稳定8只眼,视力下降2只眼,因年幼无法配合检查2只眼.所有患眼视网膜下液均有不同程度吸收.14只眼中,视网膜完全复位5只眼,占35.7％;视网膜基本复位3只眼,占21.4％;视网膜未复位6只眼,占42.8％.随访过程中发生并发性白内障2只眼,均为行玻璃体切割手术者.其余患眼均未发生全身及眼部不良反应.结论 玻璃体腔注射抗VEGF药物联合其他方法治疗晚期Coats病能稳定或提高大部分息眼视力,促进视网膜下液吸收.Objective To observe the efficacy of adjuvant intravitreal injection of anti-vascular endothelial growth factor （VEGF） therapy for advanced Coats disease.Methods This study is a retrospective case series study.Fourteen patients （14 eyes）,presenting Coats Stages 3B and 4 （8 and 6 eyes,respectively） were enrolled.All the patients were treated with adjuvant intravitreal anti-VEGF therapy.The intravitreal anti-VEGF injections varied from 1 to 7,with a median injections of 2.14.In 14 eyes,combined therapy was subretinal fluid drainage in 4 eyes,photocoagulation in 2 eyes,vitrectomy in 8 eyes.The follow-up period was ranged from 4 to 36 months,with a median follow-up of 18.8 months.Visual acuity and retinal reattachment were observed in follow up.Results At last follow up,global suvival was 100.0% with no enucleation performed in any patient because of disease progression.Except for 2 children who were unable to cope with the visual acuity test,visual acuity was improved in 2 patients,stable in 8 patients,and decreased in 2 patients.5 patients （35.7%） achieved in complete retinal reattachment,3 patients （21.4%） were succeed in partial retinal reattachment,and the remain 6 patients（42.8%） failed in retinal reattachment.Two patients developed cataract after vitrectomy,and no other adverse reaction was observed during follow-up.Conclusion Anti-VEGF therapy combined with classic treatments in advanced Coats disease can keep or impove the visual acuity in most patients by reducing of subretinal exudation.

关 键 词：视网膜毛细血管扩张症/治疗 血管生成抑制剂/治疗应用 抗体 单克隆/治疗应用 

分 类 号：R774.1[医药卫生—眼科]