视网膜下液外引流术辅助治疗重度渗出性视网膜脱离Coats病5年疗效分析  

Analysis of 5-year efficacy of adjuvant external drainage of subretinal fluid therapy in Coats disease with severe exudative retinal detachment

作　　者：李亮 李松峰 刘敬花 邓光达 麻婧 原铭贞 王天玉 卢海 Li Liang;Li Songfeng;Liu Jinghua;Deng Guangda;Ma Jing;Yuan Mingzhen;Wang Tianyu;Lu Hai(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,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、北京市眼科研究所、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼科杂志》2025年第3期173-181,共9页Chinese Journal of Ophthalmology

摘　　要：目的观察视网膜下液外引流术辅助治疗伴有重度渗出性视网膜脱离(ERD)的3B期青少年型Coats病患者的5年远期疗效和并发症。方法回顾性病例系列研究。纳入2014年1月至2018年12月在首都医科大学附属北京同仁医院就诊的伴有重度ERD的3B期青少年型Coats病患者23例(23只眼)的临床资料。患者均行广角视网膜成像、荧光素眼底血管造影术和眼彩色多普勒超声检查。患眼均行视网膜下液外引流术联合玻璃体注射抗血管内皮生长因子药物以及视网膜光凝和(或)冷凝术。观察患眼视网膜异常血管区位置和范围、血管闭锁情况、视网膜下液变化、最佳矫正视力[BCVA,以最小分辨角的对数(logMAR)表示]以及玻璃体纤维化、视网膜下纤维化、牵拉性视网膜脱离(TRD)、视网膜囊肿和并发性白内障等并发症的发生情况。采用Fisher确切概率法、校正χ^(2)检验和χ^(2)检验、Mann-WhitneyU检验、配对样本Wilcoxon符号秩检验以及Logistic回归分析进行统计学分析。结果23例患者,男性22例(95.7%),女性1例(4.3%),均为单眼发病。首次就诊年龄为43.0(38.0,47.0)个月(范围:26~129个月)。视网膜异常血管区范围为9.0(7.0,10.0)个钟点数(范围:5~12个钟点数)。患者行视网膜下液外引流术1.0(1.0,2.0)次、视网膜光凝术2.0(2.0,3.0)次、抗血管内皮生长因子药物治疗4.0(3.0,6.0)次。14只眼(60.9%)行视网膜冷凝术。随访时间66.5(64.0,70.0)个月(范围:60~89个月)。末次随访时,23例患者视网膜异常血管均完全或大部分闭锁,视网膜下液完全吸收或明显减少;其中,疗效为治愈、改善者分别为8例(34.8%)、15例(65.2%)。治愈者玻璃体纤维化、TRD和并发性白内障的发生率均低于改善者(均P<0.005)。患者中无疾病进展而行眼球摘除者。15例(15只眼)患者行BCVA检查。末次治疗后BCVA提高、稳定、下降分别为3、10、2只眼,治疗前后BCVA差异无统计学意义(P>0.05)Objective To study the 5-year long-term efficacy and complications of adjuvant external drainage of subretinal fluid therapy in patients with severe exudative retinal detachment(ERD)secondary to stage 3B juvenile Coats disease.Methods This was a retrospective case series study.From January 2014 to December 2018,twenty-three eyes of 23 patients with severe ERD secondary to stage 3B juvenile Coats disease diagnosed at Beijing Tongren Hospital,Capital Medical University were included in this study.All patients underwent wide-field retinal imaging,fluorescein fundus angiography(FFA)and ocular color Doppler imaging.All cases received external drainage of subretinal fluid therapy combined with treatments including intravitreal injection of anti-vescular edothelial growth factor(VEGF)agents,retinal photocoagulation and/or cryotherapy.Clock-hour extent and occlusion of retinal vascular telangiectasia,changes of subretinal fluid,best corrected visual acuity(BCVA,logMAR)and incidences of complications including vitreous fibrosis,subretinal fibrosis,tractional retinal detachment(TRD),retinal cyst and complicated cataract were observed.Statistical analyses were performed using Fisher′s exact test,corrected chi-square test and chi-square test,Mann-Whitney U test,paired-sample Wilcoxon signed-rank test and Logistic regression analysis.Results Among 23 eyes of 23 patients,22 patients(95.7%)were male and 1 patient(4.3%)was female.All patients had unilateral Coats disease.The median age of initial visit was 43.0(38.0,47.0)months(range,26 to 129 months).The median clock-hour extent of retinal vascular telangiectasia was 9.0(7.0,10.0)(range,5 to 12).The median time of external drainage of subretinal fluid therapy was 1.0(1.0,2.0).The median time of retinal photocoagulation was 2.0(2.0,3.0).The median time of intravitreal injection of anti-VEGF agents was 4.0(3.0,6.0).Retinal cryotherapy was performed in 14 eyes(60.9%).The median follow-up after initial treatment was 66.5(64.0,70.0)months(range,60 to 89 months).At last follow-up,r

关 键 词：视网膜毛细血管扩张症 视网膜下液 引流术 视网膜脱离 治疗结果 

分 类 号：R74[医药卫生—神经病学与精神病学]