Benlahbib Manal, Semoun Oudy, Amoroso Francesca, Colantuono Donato, Souied Eric H
Department of Ophthalmology, Hôpital Intercommunal de Créteil, Université Paris Est, Créteil, France.
Am J Ophthalmol Case Rep. 2022 Feb 26;26:101458. doi: 10.1016/j.ajoc.2022.101458. eCollection 2022 Jun.
To report the uncommon rupture of a macular macroaneurysm (MAR) during navigated retinal laser (Navilas®) focal treatment in a patient with adult onset Coats disease.
A 30-year-old man consulted for progressive decrease of vision in his right eye from one week. Fundoscopy examination showed macular hard exudates, aneurysms, vascular telangiectasias in the temporal inferior quadrant consistent with an adult onset Coats disease (CD). Spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) revealed macular edema, vessels abnormalities associate to non-perfused areas. Ultra-widefield optical coherence tomography angiography (UWF-OCTA) clearly showed the blood flow abnormalities in both superficial and deep capillary plexus. Focal laser photocoagulation of abnormal vessels by navigated retinal laser and intravitreal injections (IVT) of aflibercept, successfully resolved macular edema. During supplemental navigated focal laser treatment, a macular macroaneurysm rupture occurred, causing intravitreal hemorrhage with a self-limiting resolution in three months. Indeed, visual acuity progressively improved during follow-up and absence of macular edema was observed at 18 months.
Adult onset CD is a rare condition. Our patient presented an unusual intravitreal hemorrhagic complication due to a MAR rupture after focal navigated laser treatment. Despite this complication, early laser photocoagulation and IVT injections of anti-VEGF, successfully resolved macular edema. UWF-OCTA follow-up clearly showed abnormal vessels in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) and successfully guided additional navigated focal laser treatment.
报告1例成年型Coats病患者在导航视网膜激光（Navilas®）局灶性治疗期间黄斑大动脉瘤（MAR）罕见破裂的情况。
一名30岁男性因右眼视力在一周内逐渐下降前来就诊。眼底镜检查显示黄斑硬性渗出、动脉瘤、颞下象限血管扩张，符合成年型Coats病（CD）。光谱域光学相干断层扫描（SD-OCT）和荧光素血管造影（FA）显示黄斑水肿、与无灌注区域相关的血管异常。超广角光学相干断层扫描血管造影（UWF-OCTA）清楚地显示了浅表和深层毛细血管丛中的血流异常。通过导航视网膜激光对异常血管进行局灶性激光光凝和玻璃体内注射阿柏西普，成功消退了黄斑水肿。在补充导航局灶性激光治疗期间，发生了黄斑大动脉瘤破裂，导致玻璃体积血，三个月内自行消退。事实上，随访期间视力逐渐改善，18个月时观察到黄斑水肿消失。
成年型CD是一种罕见疾病。我们的患者在局灶性导航激光治疗后因MAR破裂出现了罕见的玻璃体积血并发症。尽管出现了这种并发症，但早期激光光凝和玻璃体内注射抗VEGF药物成功消退了黄斑水肿。UWF-OCTA随访清楚地显示了浅表毛细血管丛（SCP）和深层毛细血管丛（DCP）中的异常血管，并成功指导了额外的导航局灶性激光治疗。
