Classification and management of coats disease: The 2000 Proctor Lecture
Classification and management of coats disease: The 2000 Proctor Lecture
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DOI：
10.1016/s0002-9394(01)00896-0
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发表时间：
2001-05-01
影响因子：
4.2
通讯作者：
Cater, J
中科院分区：
文献类型：
--
作者：
Shields, JA;Shields, CL;Cater, J
目的：回顾大量 Coats 病患者的治疗方法和结果，确定视力不良和眼球摘除的危险因素，并提出 Coats 病的实用分类。 方法：在 150 名患者的回顾性连续系列研究中，Coats 病被定义为伴有视网膜内或视网膜下渗出的特发性视网膜毛细血管扩张症，无明显的视网膜或玻璃体牵拉迹象。我们回顾了我们的治疗经验，包括观察、激光光凝、冷冻疗法和各种视网膜脱离手术技术，76%的眼睛获得了改善或稳定，最终视力为20/50或更好的有11只眼睛（14%），20/60至20/100有8只眼睛（6%），20/200至手指计数有30只眼睛（24%），手部运动达到无49 只眼 (40%) 中的 20 只眼 (16%) 最终需要摘除。预测视觉效果不佳（20/200 或更差）的危险因素包括毛细血管扩张和渗出位于赤道后 (P =.01)、弥漫性 (P =.01) 或上方 (P =.04)、治疗后视网膜下液无法溶解 (P =.02) 以及视网膜的存在大囊肿 (P =.02)。眼球摘除的主要危险因素是眼压升高（大于 22 mm Hg；P 小于或等于 0.001）和虹膜新生血管形成（P 小于或等于 0.001）。Coats 病分为 1 期，仅毛细血管扩张；第 2 阶段，毛细血管扩张和渗出（2A，中心凹外渗出；2B，中心凹渗出） 第 3 阶段，渗出性视网膜脱离（3A，小计；3B，总计）；第四阶段，完全脱离和继发性青光眼；第五阶段，晚期疾病。 0% 的 1 期眼睛、53% 的 2 期眼睛、74% 的 3 期眼睛以及 100% 的 4 期和 5 期 Coats 病眼睛出现视力不良（20/200 或更差）。最终有必要进行摘除术的患者为 0% 的 1 期和 2 期患者、7% 的 3 期患者、78% 的 4 期患者和 0% 的 5 期患者。结论：精心选择的治疗可以在解剖学上稳定或改善 76% 的 Coats 病眼睛。然而，通常会导致 20/200 或更差的视力结果。 Coats 病 1 至 3 期患者的视力预后最好，4 和 5 期患者的视力预后较差。 (C) 2001 年，Elsevier Science Inc. 保留所有权利。）。
PURPOSE: To review the methods and results of management in a large series of patients with Coats disease, to determine risk factors for poor visual outcome and enucleation, and to propose a practical classification of Coats disease.METHODS: In a retrospective consecutive series in 150 patients, Coats disease was defined as idiopathic retinal telangiectasia with intraretinal or subretinal exudation without appreciable signs of retinal or vitreal traction. We reviewed our experience with management, including observation, laser photocoagulation, cryotherapy, and various techniques of retinal detachment surgery and improvement or stability was achieved in 76% of eyes, and final visual acuity was 20/50 or better in 11 eyes (14%), 20/60 to 20/100 in eight (6%), 20/200 to finger counting in 30 (24%), and hand motion to no light perception in 49 (40%) Enucleation was ultimately necessary in 20 eyes (16%).Risk factors predictive of poor visual outcome (20/200 or worse) included postequatorial (P =.01), diffuse (P =.01), or superior (P =.04) location of the telangiectasias and exudation, failed resolution of subretinal fluid after treatment (P =.02), and presence of retinal macrocysts (P =.02). The main risk factors for enucleation were elevated intraocular pressure (greater than 22 mm Hg; P less than or equal to .001) and iris neovascularization (P less than or equal to .001).Coats disease was classified into stage 1, telangiectasia only; stage 2, telangiectasia and exudation (2A, extrafoveal exudation; 2B, foveal exudation) stage 3, exudative retinal detachment (3A, subtotal; 3B, total); stage 4, total detachment and secondary glaucoma; and stage 5, advanced end-stage disease. Poor visual outcome (20/200 or worse) was found in 0% of eyes with stage 1, 53% with stage 2, 74% with stage 3, and 100% of stages 4 and 5 Coats disease. Enucleation was ultimately necessary in 0% of stages 1 and 2, 7% of stage 3, 78% of stage 4, and 0% of stage 5 disease.CONCLUSIONS: Carefully selected treatment can anatomically stabilize or improve the eye with Coats disease in 76% of eyes. However, poor visual outcome of 20/200 or worse commonly results. Patients who present with stages 1 to 3 Coats disease have the best visual prognosis, and patients with stages 4 and 5 have a poor visual prognosis. (C) 2001 by Elsevier Science Inc. All rights reserved.).