康柏西普辅助治疗青少年型Coats病远期疗效  

Long-term outcomes of adjuvant intravitreal injection of conbercept therapy in juvenile Coats disease

作　　者：李亮[1] 李松峰[1] 刘敬花[1] 邓光达[1] 麻婧[1] 原铭贞 卢海[1] Li Liang;Li Songfeng;Liu Jinghua;Deng Guangda;Ma Jing;Yuan Mingzhen;Lu Hai(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)

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、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼底病杂志》2023年第1期46-50,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：首都医科大学附属北京同仁医院青年人才培养计划种子基金(2021-YJJ-ZR-010、2020-YJJ-ZZL-017)。

摘　　要：目的观察玻璃体腔注射康柏西普(IVC)辅助治疗青少年型Coats病的远期疗效。方法回顾性病例系列研究。2015年1月1日至2018年12月31日于首都医科大学附属北京同仁医院眼科检查确诊的青少年型Coats病患者40例40只眼纳入研究。其中,男性37例,女性3例;均为单眼发病。年龄55.00(44.75,81.25)个月。2B、3A、3B、4期分别为5、15、19、1只眼。眼底检查均可见视网膜异常血管、广泛视网膜下液(SRF,3期及以上)或黄斑区大范围渗出及水肿(2B期)。患眼均行超广角眼底彩色照相、荧光素眼底血管造影检查。行最佳矫正视力(BCVA)检查31只眼。BCVA检查采用标准对数视力表进行,并转换为最小分辨角对数(logMAR)视力记录。患眼均行IVC联合视网膜激光光凝等治疗。IVC注射中位数4(1,5)次。治疗后随访时间59.00(52.50,63.00)个月,观察患眼BCVA、视网膜异常血管闭锁、SRF吸收以及眼部和全身并发症发生情况。结果末次随访时,行BCVA检查的31只眼中,BCVA提高、稳定、下降分别为13(32.5%,13/40)、12(30.0%,12/40)、6(15.0%,6/40)只眼。治疗前后不同分期患眼平均logMAR BCVA比较,差异无统计学意义(Z=-0.56、-1.80、-0.84,P>0.05)。所有患眼视网膜异常血管均部分或完全闭锁,SRF减少或完全吸收。其中,治愈、改善分别为28(70.0%,28/40)、12(30.0%,12/40)只眼;无眼球摘除者。发生玻璃体视网膜纤维化19只眼(47.5%,19/40);牵拉性视网膜脱离8只眼(20.0%,8/40);并发性白内障15只眼(37.5%,15/40)。随访期间均未出现与IVC治疗相关的眼部及全身并发症。结论IVC联合视网膜激光光凝等其他方法治疗可稳定或提高多数青少年型Coats病患眼视力,促进SRF吸收;IVC是一种远期安全且有效的辅助治疗方法。Objective To study the long-term effects and outcomes of adjuvant intravitreal injection of conbercept(IVC)therapy in juvenile Coats disease.Methods A retrospective case series study.From January 1,2015 to December 31,2018,40 patients(40 eyes)who were diagnosed as juvenile Coats disease at Beijing Tongren Hospital Affiliated to Capital Medical University were included in the study.Among them,there were 37 males(37 eyes)and 3 females(3 eyes).All patients had unilateral Coats disease.The average age was 55.00(44.75,81.25)months.Five eyes were in stage 2B,15 eyes were in stage 3A,19 eyes were in stage 3B and 1 eye was in stage 4.Idiopathic retinal vascular telangiectasia associated with extensive subretinal fluid(SRF)(stage 3 or above)or massive foveal exudation and edema(stage 2B)were found in fundus examination.All affected eyes underwent wide-field color fundus images and fluorescein fundus angiography.Thirty-one eyes underwent best corrected visual acuity(BCVA)examination.The BCVA was carried out using a standard logarithmic visual acuity chart,which was converted into the logarithmic minimum angle of resolution(logMAR)visual acuity.All cases received adjuvant IVC combined with treatments such as retinal photocoagulation.The average number of injections was 4(1,5).The average follow-up after initial treatment was 59.00(52.50,63.00)months.The changes in BCVA,occlusion of abnormal blood vessels in fundus,absorption of SRF and ocular and systemic complications were observed.Results At last follow-up,among 31 affected eyes with the examination of BCVA,13(32.5%,13/40)eyes had an improved vision,12 eyes(30.0%,12/40)had a stable vision and 6 eyes(15.0%,6/40)had a decreased vision.The difference between average logMAR BCVA of the affected eyes in each stage after treatment and that before treatment was not statistically significant(Z=-0.56,-1.80,-0.84;P>0.05).Abnormal blood vessels in fundus were all partially or completely occluded,and SRF was obviously or completely absorbed in all cases;of which,28 eyes(70.0%,28/40)w

关 键 词：COATS病 康柏西普 血管生成抑制剂 激光凝固术 

分 类 号：R774.1[医药卫生—眼科]