351 只眼中的 Coats 病：单一中心 45 年（每十年为一个阶段）的特征和结局分析。
Coats disease in 351 eyes: Analysis of features and outcomes over 45 years (by decade) at a single center.
机构信息
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, USA.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA; Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905, USA.
出版信息
Indian J Ophthalmol. 2019 Jun;67(6):772-783. doi: 10.4103/ijo.IJO_449_19.
PURPOSE
To assess features and outcomes of Coats disease over 5-decades.
METHODS
Retrospective review of Coats disease patients at a single center. Features and outcomes were compared based on decade of presentation.
RESULTS
There were 351 patients with Coats disease. The presenting median age (6 years), male sex (84%), and unilaterality (100%) did not change per decade. Coats disease classification did not change per decade with Stage 1 (1%), Stage 2 (21%), Stage 3 (68%), Stage 4 (6%), and Stage 5 (1%). Clinical features that changed per decade (1970s vs. 1980s vs. 1990s vs. 2000s vs. 2010s) included 1980s features of more eyes with exudation in all 4 quadrants (22% vs. 58% vs. 44% vs. 33% vs. 27, P = 0.01) and total exudative retinal detachment (33% vs. 53% vs. 39% vs. 27% vs. 21%, P < 0.001). Imaging features that changed per decade included 2010s greater fluorescein angiographic extent of retinal non-perfusion in mean clock hours (4 vs. 4 vs. 3 vs. 5 vs. 6, P = 0.003), and 1980s greater mean height of retinal detachment ultrasonographically (5 vs. 12 vs. 5 vs. 5 vs. 4 mm, P < 0.001). Treatment features that changed per decade included 1980s greater primary enucleation (11% vs. 16% vs. 3% vs. 4% vs. 1%, P = 0.001), and 2010s greater use of laser photocoagulation (55% vs. 33% vs. 38% vs. 40% vs. 72%, P < 0.001), sub-Tenon corticosteroid (0% vs. 4% vs. 5% vs. 8% vs. 29%, P < 0.001), and intravitreal anti-VEGF) (0% vs. 4% vs. 2% vs. 13% vs. 18%, P = 0.003). Outcomes that changed per decade included 2010s findings of more complete resolution of subretinal fluid (64% vs. 59% vs. 38% vs. 58% vs. 72%, P = 0.01) and less need for primary/secondary enucleation (17% vs. 27% vs. 14% vs. 13% vs. 6%, P = 0.04).
CONCLUSION
Eyes with Coats disease in the 1980s demonstrated more advanced findings, often requiring enucleation. Over the decades, greater use of laser photocoagulation and injections has led to improved disease resolution with greater globe salvage.
目的
评估超过 50 年来 Coats 病的特征和结局。
方法
对单中心 Coats 病患者进行回顾性研究。根据发病时间的不同，比较特征和结局。
结果
共有 351 例 Coats 病患者。首发中位年龄（6 岁）、男性比例（84%）和单侧性（100%）在每个十年中均无变化。Coats 病分期也无变化，1 期（1%）、2 期（21%）、3 期（68%）、4 期（6%）和 5 期（1%）。1970 年代至 1980 年代至 1990 年代至 2000 年代至 2010 年代，每年的临床特征都有所变化，包括 1980 年代，所有四个象限中渗出的眼睛更多（22%比 58%比 44%比 33%比 27%，P=0.01）和全层渗出性视网膜脱离（33%比 53%比 39%比 27%比 21%，P<0.001）。每年的影像学特征也有所变化，包括 2010 年代，荧光素血管造影中视网膜无灌注的平均时钟小时范围更大（4 比 4 比 3 比 5 比 6，P=0.003）和 1980 年代，超声检查中视网膜脱离的平均高度更高（5 比 12 比 5 比 5 比 4 毫米，P<0.001）。每年的治疗特征也有所变化，包括 1980 年代，初次眼球摘除术更多（11%比 16%比 3%比 4%比 1%，P=0.001）和 2010 年代，激光光凝术更多（55%比 33%比 38%比 40%比 72%，P<0.001）、经Tenon 下皮质类固醇（0%比 4%比 5%比 8%比 29%，P<0.001）和玻璃体内抗血管内皮生长因子治疗（0%比 4%比 2%比 13%比 18%，P=0.003）。每年的结局也有所变化，包括 2010 年代，视网膜下液完全消退的比例更高（64%比 59%比 38%比 58%比 72%，P=0.01）和需要初次/二次眼球摘除术的比例更低（17%比 27%比 14%比 13%比 6%，P=0.04）。
结论
1980 年代的 Coats 病患者表现出更严重的病情，通常需要眼球摘除。几十年来，激光光凝术和注射治疗的广泛应用导致疾病缓解率提高，眼球保留率提高。
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