Al-Qahtani Abdullah A, Almasaud Jluwi M, Ghazi Nicola G
*Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; and †Department of Ophthalmology, University of Virginia, Charlottesville, Virginia.
Retina. 2015 Oct;35(10):2091-9. doi: 10.1097/IAE.0000000000000594.
To present the clinical aspects and treatment outcomes of Coats disease in Saudi Arabia.
A retrospective chart review was performed of 92 patients (97 eyes) diagnosed with Coats disease at King Khalid Eye Specialist Hospital from 1983 to 2010.
The most common presenting complaint was decreased visual acuity followed by strabismus and then leukocoria. Snellen visual acuity was 20/20 to 20/50 in 9 eyes (9%), 20/50 to 20/160 in 11 eyes (11%), 20/200-counting fingers in 29 eyes (30%), and hand motion to no light perception in 24 eyes (25%). Telangiectasia was located in the preequatorial area in 71 eyes (73%) and most commonly involved the temporal retina in 67 eyes (69%). In eyes with clear view to the fundus, quadrant involvement by telangiectasia had the following distribution: 1) quadrant (n = 36, 37%); 2) quadrants (n = 26, 27%); 3) quadrants (n = 8, 8%); and 4 quadrants (n = 15, 15%). Total retinal detachment was present at presentation in 28 eyes (29%) and neovascular glaucoma in 8 (8%). Based on the Shields classification, the eyes were Stage 1 (n = 1, 1%), Stage 2A (n = 7, 7%), Stage 2B (n = 23, 24%), Stage 3A1 (n = 26, 27%), Stage 3A2 (n = 12, 12%), Stage 3B (n = 16, 17%), Stage 4 (n = 11, 11%), and Stage 5 (n = 5, 1%). Stage 3A was the most commonly presented stage (39%). Primary management included cryotherapy (19%), laser photocoagulation (64%), intravitreal agents (9%), and surgical drainage (4%). Combination treatment was performed in 29% of eyes. Thirteen eyes (13%) were enucleated because of clinical suspicion of retinoblastoma or the presence of glaucoma. Factors that were associated with a poor visual outcome of 20/200 or worse included age less than 10 years (relative risk: 1.27), Stages 3 and 4 disease (relative risk: 1.40), presence of subretinal fluid in all 4 quadrants including the fovea (relative risk: 14.25), and initial visual acuity of 20/200 (relative risk: 6.72) or worse (P < 0.005 for all factors).
Although rare, Coats disease is usually advanced at presentation and has a poor visual prognosis in the Saudi population, like in other populations. The findings of this study give validity and applicability to the Shields staging scheme, which we recommend using in clinical practice.
介绍沙特阿拉伯科茨病的临床特征及治疗结果。
对1983年至2010年在沙特国王哈立德眼科专科医院确诊为科茨病的92例患者（97只眼）进行回顾性病历分析。
最常见的就诊主诉是视力下降，其次是斜视，然后是白瞳症。9只眼（9%）的斯内伦视力为20/20至20/50，11只眼（11%）为20/50至20/160，29只眼（30%）为20/200至数指，24只眼（25%）为手动至无光感。71只眼（73%）的毛细血管扩张位于赤道前区域，其中67只眼（69%）最常累及颞侧视网膜。在眼底清晰可见的眼中，毛细血管扩张累及象限的分布如下：1个象限（n = 36，37%）；2个象限（n = 26，27%）；3个象限（n = 8，8%）；4个象限（n = 15，15%）。28只眼（29%）初诊时存在视网膜全脱离，8只眼（8%）存在新生血管性青光眼。根据Shields分类，这些眼为1期（n = 1，1%）、2A期（n = 7，7%）、2B期（n = 23，24%）、3A1期（n = 26，27%）、3A2期（n = 12，12%）、3B期（n = 16，17%）、4期（n = 11，11%）和5期（n = 5，1%）。3A期是最常见的分期（39%）。主要治疗方法包括冷冻疗法（19%）、激光光凝（64%）、玻璃体内注射药物（9%）和手术引流（4%）。29%的眼进行了联合治疗。13只眼（13%）因临床怀疑视网膜母细胞瘤或存在青光眼而被摘除眼球。与视力预后差（20/200或更差）相关的因素包括年龄小于10岁（相对危险度：1.27）、3期和4期疾病（相对危险度：1.40）、包括黄斑区在内的所有4个象限存在视网膜下液（相对危险度：14.25）以及初始视力为20/200（相对危险度：6.72）或更差（所有因素P < 0.005）。
尽管科茨病罕见，但在沙特人群中，其初诊时通常已处于晚期，视力预后较差，与其他人群一样。本研究结果验证了Shields分期方案的有效性和适用性，我们建议在临床实践中使用该方案。
