Elnahry Ayman G, Sallam Essam M, Guirguis Kirollos J, Talbet Joseph H, Abdel-Kader Ahmed A
Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Howard University, College of Medicine, Washington, DC, USA.
Am J Ophthalmol Case Rep. 2019 Jul 9;15:100508. doi: 10.1016/j.ajoc.2019.100508. eCollection 2019 Sep.
To report a case of adult-onset Coats' disease that had worsening of macular edema and progressive macular traction following cryotherapy and repeated intravitreal bevacizumab injections due to formation of a secondary epiretinal membrane which only improved following pars plana vitrectomy and membrane peeling.
A 35-year-old male presented with diminution of vision in his left eye and was found to have localized telangiectatic retinal vessels and aneurysmal dilatations with massive exudation and cystoid macular edema. He was diagnosed as adult-onset Coats' disease and treated with cryotherapy and a concomitant intravitreal injection of 2.5 mg bevacizumab followed by 3 monthly intravitreal injections of 2.5 mg bevacizumab and a single injection of 4 mg triamcinolone acetonide. Partial obliteration of the telangiectatic vessels and aneurysmal dilatations with improvement in surrounding lipid and fluid exudate was achieved, however, this was associated with progressive worsening of macular edema and macular traction due to formation of an epiretinal membrane which only improved following vitrectomy and membrane peeling. Effect of therapy at each stage was evaluated using visual acuity testing, fundus examination, fundus fluorescein angiography, and optical coherence tomography.
A secondary epiretinal membrane can develop following treatment of adult-onset Coats' disease and cause traction especially when combining cryotherapy with bevacizumab injections. Vitrectomy in such cases with membrane peeling may result in improvement of anatomical and functional outcomes.
报告一例成人型Coats病病例，该病例在冷冻治疗及多次玻璃体内注射贝伐单抗后，黄斑水肿加重且黄斑牵拉进展，原因是形成了继发性视网膜前膜，而这一情况仅在经平坦部玻璃体切除术及膜剥除术后才得到改善。
一名35岁男性因左眼视力下降就诊，检查发现局部视网膜血管扩张及动脉瘤样扩张，伴有大量渗出及黄斑囊样水肿。他被诊断为成人型Coats病，接受了冷冻治疗，并同时玻璃体内注射2.5mg贝伐单抗，随后每月玻璃体内注射2.5mg贝伐单抗3次，单次注射4mg曲安奈德。扩张的血管及动脉瘤样扩张部分闭塞，周围脂质及液体渗出有所改善，然而，这与黄斑水肿及黄斑牵拉的逐渐加重相关，原因是形成了视网膜前膜，而这一情况仅在玻璃体切除术及膜剥除术后才得到改善。在每个阶段，通过视力测试、眼底检查、眼底荧光血管造影及光学相干断层扫描评估治疗效果。
成人型Coats病治疗后可能会形成继发性视网膜前膜，并导致牵拉，尤其是在冷冻治疗联合贝伐单抗注射时。在此类病例中，行玻璃体切除术并剥除视网膜前膜可能会改善解剖及功能预后。
