Oli Avadhesh, Balakrishnan Divya, Jalali Subhadra
L V Prasad Eye Institute, Hyderabad, India.
L V Prasad Eye Institute, Kallam Anji Reddy Campus, L. V. Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, India.
Ther Adv Ophthalmol. 2021 Dec 5;13:25158414211055957. doi: 10.1177/25158414211055957. eCollection 2021 Jan-Dec.
The long-term treatment outcomes in Coat's disease - particularly in the era of newer pharmacotherapies such as anti-vascular endothelial growth factor (VEGF) agents and depot steroids - are poorly understood.
To describe the clinical features and treatment outcomes of 148 eyes with Coats' disease assessed in a referral centre over 30 years.
We conducted a retrospective chart review of patients diagnosed with Coats' disease between 1 June 1987 and 31 July 2017. The demographic, clinical and treatment data were collected and long-term functional and anatomical outcomes were analysed based on the treatment either with conventional therapy (cryo/laser) or along with adjuvants like intravitreal steroids or anti-VEGFs.
The mean age at presentation was 15.22 years (median 11). Familial exudative vitreoretinopathy was the most common referral diagnosis, 76/148 (51.5%), followed by Coats' disease, 37/148 (25%), and retinoblastoma, 35/148 (23.6%). Stage 3B was most common at presentation (31.8%), followed by 2B (22.3%) and 2A (16.9%). A total of 107 patients were treated either with conventional therapy or in combination with adjuvants. The mean follow-up period was 24.95 months. The visual acuity improved from baseline logMAR 2.17 (Snellen-20/2958) to logMAR 1.88 (Snellen-20/1517) at final follow-up ( = 0.004). The improvement in visual acuity was better when the presenting BCVA was <1 logMAR (Snellen 20/200), = 0.004. No statistically significant change in BCVA was noted between conventional and adjuvant groups, = 0.5. However, the final anatomical outcome was good in 78/99 (78.8%) in the conventional group and 45/49 (91.8%) in the adjuvant group, respectively ( = 0.046).
In this series of patients with Coats' disease over three decades, the use of intravitreal steroids or anti-VEGFs as adjuvants resulted in better anatomical outcomes. A better baseline visual acuity, lower stage of the disease, and older age at presentation were found to be the factors leading to favourable visual outcomes.
In the current series of 148 eyes with Coats' disease, adjuvant treatment with intravitreal steroids or anti-VEGFs resulted in better outcomes as compared with conventional cryotherapy or laser photocoagulation alone. Patients with Coats' disease who had presented with better visual acuity at baseline, lower stage of the disease and older age had better final visual outcomes.
视网膜毛细血管扩张症的长期治疗效果——尤其是在抗血管内皮生长因子（VEGF）药物和长效类固醇等新型药物治疗时代——了解甚少。
描述在一家转诊中心30年间评估的148例视网膜毛细血管扩张症患者的临床特征和治疗效果。
我们对1987年6月1日至2017年7月31日期间诊断为视网膜毛细血管扩张症的患者进行了回顾性病历审查。收集了人口统计学、临床和治疗数据，并根据传统治疗（冷冻/激光）或联合玻璃体内类固醇或抗VEGF等辅助药物的治疗情况，分析了长期功能和解剖学结果。
就诊时的平均年龄为15.22岁（中位数11岁）。家族性渗出性玻璃体视网膜病变是最常见的转诊诊断，76/148（51.5%），其次是视网膜毛细血管扩张症，37/148（25%），以及视网膜母细胞瘤，35/148（23.6%）。就诊时3B期最常见（31.8%），其次是2B期（22.3%）和2A期（16.9%）。共有107例患者接受了传统治疗或联合辅助药物治疗。平均随访期为24.95个月。末次随访时，视力从基线的logMAR 2.17（Snellen-20/2958）提高到logMAR 1.88（Snellen-20/1517）（P = 0.004）。当初始最佳矫正视力（BCVA）<1 logMAR（Snellen 20/200）时，视力改善更好，P = 0.004。传统治疗组和辅助治疗组之间的BCVA无统计学显著变化，P = 0.5。然而，传统治疗组99例中有78例（78.8%）最终解剖学结果良好，辅助治疗组49例中有45例（91.8%）最终解剖学结果良好，分别为（P = 0.046）。
在这组长达三十年的视网膜毛细血管扩张症患者中，使用玻璃体内类固醇或抗VEGF作为辅助药物可带来更好的解剖学结果。发现更好的基线视力、疾病分期较低和就诊时年龄较大是导致良好视力结果的因素。
在当前这组148例视网膜毛细血管扩张症患者中，与单独的传统冷冻疗法或激光光凝相比，玻璃体内类固醇或抗VEGF辅助治疗可带来更好的结果。基线视力较好、疾病分期较低且就诊时年龄较大的视网膜毛细血管扩张症患者最终视力结果更好。
