视网膜下液引流联合玻璃体内注射抗血管内皮生长因子药物治疗重度渗出性视网膜脱离Coats病的临床疗效  

Subretinal fluid drainage combined with intravitreal injection of anti-vascular endothelial growth factor in treatment of severe exudative retinal detachment Coats disease

作　　者：李松峰[1] 邓光达[1] 刘敬花[1] 马燕[1] 卢海[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心,北京市100730

出　　处：《眼科新进展》2017年第6期569-571,共3页Recent Advances in Ophthalmology

基　　金：首都临床特色应用研究项目(编号:Z141107002514029)~~

摘　　要：目的研究视网膜下液引流联合玻璃体内注射抗血管内皮生长因子药物雷珠单抗治疗重度渗出性视网膜脱离Coats病的效果。方法选取2013年4月至2017年1月在北京同仁医院眼科中心确诊为3B期Coats病的患者13例13眼纳入研究。13例患者中,视力为无光感1例,光感~数指7例,0.01~0.1者2例,因年幼无法配合检查3例。巩膜外放液选取位置在视网膜脱离较高的位置,在显微镜观察下缓慢放出视网膜下液,所有患眼放液后于角膜缘后3.5 mm睫状体平坦部行玻璃体内注射抗血管内皮生长因子药物雷珠单抗0.5 mg(0.05 mL)。随访期观察患者的视力、眼压、裂隙灯、间接检眼镜及彩色眼底像。分析异常血管变化,视网膜下液及渗出的吸收情况,视网膜复位及并发症发生情况。结果 13例患者中3例进行了2次的视网膜下液引流,10例进行了1次的视网膜下液引流;联合两次玻璃体内注射雷珠单抗的有6例,联合三次注射的4例,三次以上3例。所有患者的视网膜下液吸收或者大部分吸收后,进行了视网膜冷冻或激光治疗,单纯激光治疗的有5例,单纯视网膜冷冻治疗的3例,激光联合冷冻治疗的5例。13例患者中,视力提高的2例,无变化的8例,因年幼无法配合检查3例。在随访中,8例视网膜完全复位,未观察到与视网膜下液引流和眼内注药手术操作相关的并发症,如眼内炎、视网膜裂孔、玻璃体积血等。结论视网膜下液引流联合玻璃体内注射雷珠单抗是一种有效治疗重度3B期Coats病的方法 。Objective To investigate the effects of subretinal fluid drainage com- bined with intravitreal anti-vascular endothelial growth factor （VEGF） drugs in the treatment of severe exudative retinal detachment Coats disease. Methods Thirteen patients （ 13 eyes） with 3B Coats＇ disease diagnosed at the Eye Center of Tongren Hos- pital were included in the study. The participants were aged from l year to 11 years with a mean age of （4.15 ＋2.99）years. The visual acuity was no light perception in 1 case, from light perception to counting finger in 7 cases, from 0. 01 to 0. 1 in 2 cases, and could not be measured due to young in 3 cases. Patients underwent retinal fluid drainage combined with intravitreal ranibizumab （ IVR,0.5 mg ,0.05 mL） at the pars plana of cili- ary body, and with retinal laser photocoagulation or cryotherapy according to the retinal peripheral vascular activity. During the follow-up, the visual acuity, intraocular pressure, slit lamp, indirect ophthalmoscope and color ophthalmoscope were examined and ob- served. The abnormal blood vessel change, absorption of subretinal fluid, retinal reat- tachment and complication were observed. Results Two subretinal fluid drainage were performed in 3 cases, one subretinal fluid drainage in 10 cases. Six cases were combined with two intravitreal injections ,4 cases with three intravitral injection ,3 cases with intravitreal injection for more than three times. Five cases were treated with simple photocoagulation,3 cases with simple retinal cryotherapy, and 5 cases with laser com- bined with cryotherapy. In 13 patients, the visual acuity was improved in 2 cases, un- changed in 8 cases, and could not be measured due to young in 3 cases. Eight cases had complete retinal reattachment. No significant postoperative complications occurred dur- ing follow-up, such as endophthalmitis, retinal hole and vitreous hemorrhage. Conclusion Subretinai fluid drainage combined with intravitreal injection is an effective method for severe 3B stage Coats disease.

关 键 词：COATS病 视网膜下液引流 抗血管内皮生长因子 

分 类 号：R774[医药卫生—眼科]