Pérez-Campagne Eric, Wolfensberger Thomas J
Hôpital Ophtalmique Jules Gonin, Université de Lausanne, Lausanne, Switzerland.
Eur J Ophthalmol. 2012 May-Jun;22(3):509-12. doi: 10.5301/ejo.5000040.
We describe an atypical case of a patient with Coats disease that re-emerged after 30 years, illustrating a previously poorly understood long-term evolution of the disease.
A 20-year-old man consulted for visual acuity (VA) decrease in the left eye (LE) to 0.3. Fundus examination revealed an exudative lesion with telangiectasias in the superior peripheral retina compatible with the diagnosis of Coats disease.
The patient was treated with cryotherapy and argon laser. Visual acuity improved to 0.5 and remained stable during a 1-year follow-up. The patient did not seek further clinical follow-up. Thirty years later, he returned complaining of a progressive VA decrease in the LE. Snellen VA was measured to counting fingers. Fundus examination revealed stage 3A Coats disease with macular exudation and a serous retinal detachment in the inferior quadrants requiring the placement of an encircling band, external drainage, and cryotherapy of the vascular lesions. After 10 additional sessions of argon laser on the vascular malformations, exudation regressed further and best-corrected VA increased to 0.1 at the end of the follow-up period.
Coats disease must be considered as a chronic disease, which necessitates a very long-term follow-up even in the absence of subjective visual loss. The disease can reawaken and recur with force in previously unaffected areas of the retina several decades later. The gold standard treatment consists of cryotherapy and argon laser. However, in cases of very important retinal exudation, surgical management with subretinal drainage may be necessary.
我们描述了一例30年后复发的Coats病非典型病例，阐明了此前了解甚少的该疾病长期演变情况。
一名20岁男性因左眼视力降至0.3前来就诊。眼底检查发现视网膜周边上象限有一处伴有毛细血管扩张的渗出性病变，符合Coats病的诊断。
该患者接受了冷冻疗法和氩激光治疗。视力提高到0.5，并在1年的随访期间保持稳定。患者未寻求进一步的临床随访。30年后，他回来抱怨左眼视力进行性下降。测得Snellen视力为指数。眼底检查显示为3A期Coats病，伴有黄斑渗出和视网膜下象限的浆液性视网膜脱离，需要放置环扎带、进行外引流以及对血管病变进行冷冻治疗。在对血管畸形额外进行10次氩激光治疗后，渗出进一步消退，随访期末最佳矫正视力提高到0.1。
Coats病必须被视为一种慢性疾病，即使在没有主观视力丧失的情况下也需要非常长期的随访。该疾病可能在几十年后在视网膜先前未受影响的区域重新发作并强力复发。金标准治疗包括冷冻疗法和氩激光。然而，在视网膜渗出非常严重的情况下，可能需要进行视网膜下引流的手术治疗。
