Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction
Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction
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DOI：
10.1136/bjophthalmol-2011-300141
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发表时间：
2012-03-01
影响因子：
4.1
通讯作者：
Shields, Carol L.
中科院分区：
文献类型：
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作者：
Ramasubramanian, Aparna;Shields, Carol L.
目的评价玻璃体内注射贝伐单抗治疗Coats病的疗效。方法回顾分析8例Coats病合并视网膜毛细血管扩张症患者，采用标准激光光凝和(或)冷凝联合玻璃体腔内注射贝伐单抗(1.25 mg/0.05ml)治疗。Coats病2期1例(12%)，3a期3例(38%)，3b期4例(50%)。临床表现包括视网膜脱离(n=8,100%，平均脱离时间8小时)，毛细血管扩张(n=8,100%，平均时间8小时)，荧光素血管造影显示周边视网膜缺血(n=7，88%)，无新生血管形成。治疗包括冷冻治疗(n=8,100%)、激光光凝(n=4，50%)和贝伐单抗玻璃体腔注射(n=8)，中位数为1次/眼(平均1.75次，注射次数1~4次)。平均随访8.5个月，视网膜病变消退8例(100%)，Coats相关视网膜下积液8例(100%)，视网膜渗出6例(75%)。然而，在平均注射1.75次贝伐单抗后，平均5个月出现玻璃体纤维化(n=4，50%)，其中3次(38%)进展为牵引性视网膜脱离。结论Coats病在标准治疗的基础上，玻璃体腔内注射贝伐单抗可发展为玻璃体视网膜纤维化和潜在的牵引性视网膜脱离。这些牵引力特征在没有贝伐单抗的标准措施治疗的Coats病中并不常见。对于Coats病患者，建议谨慎使用贝伐单抗。
Aim To evaluate the effect of supplemental intravitreal bevacizumab for management of Coats' disease.Methods Retrospective analysis of eight patients with Coats' disease manifesting total or partial exudative retinal detachment where the retinal telangiectasia was treated with standard laser photocoagulation and/or cryotherapy plus additional intravitreal bevacizumab (1.25 mg/0.05 ml).Results The mean patient age was 88 (range 7-240) months and 63% were male. Coats' disease was classified as stage 2 (n = 1, 12%), 3a (n = 3, 38%) and 3b (n = 4, 50%). Features included retinal detachment (n = 8, 100% with mean detachment extent involving 8 clock hours), telangiectasia (n = 8, 100% with mean extent of 8 clock hours), peripheral retinal ischaemia on fluorescein angiography (n = 7, 88%) and no evidence of neovascularisation. Treatment consisted of cryotherapy (n = 8, 100%), laser photocoagulation (n = 4, 50%) and bevacizumab intravitreal injection (n = 8) with median number of one injection per eye (mean 1.75, and range 1-4 injections). After a mean follow-up of 8.5 months, resolution of retinopathy (n = 8, 100%), Coats'-related subretinal fluid (n = 8, 100%) and retinal exudation (n = 6, 75%) was noted. However, vitreous fibrosis developed (n = 4, 50%) at a mean of 5 months following a mean of 1.75 bevacizumab injections with three (38%) evolving into traction retinal detachment.Conclusion Coats' disease treated with intravitreal bevacizumab in addition to standard therapy can develop to vitreoretinal fibrosis and potentially traction retinal detachment. These tractional features are not often found in Coats' disease treated with standard measures without bevacizumab. Caution is advised in the use of bevacizumab for patients with Coats' disease.