抗VEGF药物联合激光治疗成人型Coats病的临床分析

抗VEGF药物联合激光治疗成人型Coats病的临床分析

蒋 莉，李 劲，彭 伟 【摘 要】摘要：

【期刊名称】国际眼科杂志 【年(卷),期】2017(017)007 【总页数】3

【关键词】康柏西普；成人型Coats病；视网膜疾病 ·临床报告·

?AIM: To analyze clinical observation and the efficiency of intravitreal conbercept combined with 532-laser on Coats disease in adulthood. ?METHODS: This was an retrospective analysis. Six eyes from 6 patients(5 males and 1 female) with coats disease diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled. Before the injection, best-corrected visual acuity (BCVA) of early treatment of diabetic retinopathy study (ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, FFA, and OCT were examined. The initial average visual acuity (ETDRS letters) were 51.17±15.15. The initial average central retina thickness (CRT) was 303.30±107.87μm. All affected eyes were treated with intravitreal conbercept 0.05mL (10mg/mL) combined with 532-laser. Patients were followed up for 6 to 12mo, with a mean duration of 7.33±1.26mo. Post-treatment BCVA were compared with baseline using repeat analysis.

?RESULTS: The mean BCVA showed significant improvement during 1 wk, 1, 3mo post-treatment and the latest follow up (P<0.01). During the latest follow up, the mean BCVA was obviously improved in 3 eyes (50%), improved in 2 eyes (40%), stable in 1 eyes (10%). Likewise, the subretina fluid absorption of different levels. No adverse events such as secondary retinal detachment or endophthalmitis were found during the follow-up.

?CONCLUSION: Coats disease in adulthood more likely to have lower symptom and have a better response on treatment. Intravitreal conbercept combined with 532-laser significantly improve visual acuity and absorb the subretina fluid.

目的：探讨18岁以上成年型Coats病的临床特点及抗VEGF药物联合激光治疗的有效性及安全性。

方法：回顾性分析我院眼科2015-01/2016-06期间经荧光素眼底血管造影(FFA)及光学相干断层扫描(optical coherence tomography，OCT)检查确诊的成人型Coats病患者6例6眼。采用糖尿病视网膜病变早期治疗研究视力表(ETDRS)检查最佳矫正视力(BCVA)，OCT检查测量黄斑中心厚度(CMT)。患眼平均BCVA为51.17±15.15个字母；CRT为221～673(平均303.30±107.87)μm。所有患眼玻璃体腔注射10mg/mL康柏西普0.05mL(含康柏西普0.5mg)，1wk后给予532nm激光光凝病变视网膜组织，平均随访时间7.33±1.26mo。仔细阅读FFA检查图像，分析成人型Coats病的临床特点，对比分析治疗前后患眼BCVA的变化，同时观察随访期间眼部与全身不良反应

的发生情况。

结果：治疗后1wk，1、3mo及末次随访时，患眼平均BCVA均较治疗前提高，差异均有统计学意义(均P<0.01)。治疗后1mo平均BCVA提高的字母数与末次随访相比，差异有统计学意义(P<0.01)，末次随访时，显著提高3眼(50%)，提高2眼(40%)，稳定1眼(10%)；治疗后患眼视网膜下液均有不同程度减少，随访期间均未见与治疗相关的严重眼部及全身并发症。

结论：成人型Coats病视网膜血管异常扩张范围局限，进展缓慢，治疗预后好，抗VEGF联合激光治疗能够提高患眼视力，减少视网膜积液，安全性好。

0引言

Coats病又名渗出性视网膜外层病变，主要临床特征为视网膜毛细血管扩张，粟粒状动脉瘤或小动脉瘤、视网膜内及视网膜下黄白色渗出。文献报告Coats病发病多以青少年为主，但也可见于高龄患者[1-2]，但是关于成年型Coats病患者的临床诊疗资料国内报道较少见。近年有研究显示，血管内皮生长因子(vascular endothelium growth factor，VEGF)在Coats 病患眼中呈高浓度表达[3-5]，玻璃体腔注射抗VEGF药物治疗通过降低VEGF浓度，可以稳定或退化异常的血管、促进视网膜下积液及渗出的吸收，但目前抗VEGF药物治疗Coats病的临床资料并不多见，因此，本研究回顾分析近2a来我院眼科确诊的一组年龄大于18岁、接受玻璃体腔内注射抗VEGF药物联合激光治疗并坚持随访的Coats病患者，现将临床资料分析总结如下。

1对象和方法

1.1对象 回顾性分析。选取2015-01/2016-06在深圳市人民医院眼科就诊，经眼底检查、荧光素眼底血管造影(fluorescein fundus angiography，FFA)及