Abatli Safaa, Shweiki Sameeha Ziad
Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, PO Box 219, Nablus, State of Palestine.
Vitreoretinal Surgery Department, Hugo Chavez Hospital, Turmus Ayya, State of Palestine.
BMC Ophthalmol. 2025 Jan 6;25(1):8. doi: 10.1186/s12886-024-03829-4.
This case report describes a rare case of Coats disease in adult female patient with preserved vision after intravitreal Aflibercept injection and laser photocoagulation.
A female patient of Asian Palestinian descent, aged 20, exhibited a progressive and painless deterioration in the vision of her left eye over a period of two weeks. She exhibited no additional ocular symptoms. Prior to her presentation, she had no notable medical history and her vision was normal in both eyes. Inferotemporal telangiectasia, sausage-like blood vessels with perivascular sheathing in the peripheral fundus, extensive exudate involving the macula, severe macular edema, and localized inferotemporal exudative retinal detachment were observed upon examination of the posterior segment of her left eye. Following this, optical coherence tomography (OCT) identified subretinal exudate, intraretinal and subretinal fluid. After establishing the diagnosis of stage 3 Coats' disease, the patient was treated with intravitreal Aflibercept (Eylea) injections and sectoral laser photocagulation. The third injection resulted in the absence of intraretinal and subretinal fluid by OCT, but the subretinal exudate remained unresolved. One month subsequent to the previous injection, FFA guided sectoral laser photoagulation was applied to the inferiotemporal ischemic area. The patient was subsequently monitored monthly, and her vision improved. Five months after treatment, her vision has improved to 0.7 (6/8.7) and she has remained stable ever since. At present, the patient is undergoing routine outpatient follow-up.
Coats disease is an idiopathic, progressive disease that mostly affects male infants, yet adult cases have been documented. Our case and the existing body of literature indicate that adult individuals have a favorable visual prognosis in the small proportion of cases where this occurs. It appeared that the implementation of intravitreal therapies and increased use of lasers led to enhanced visual outcomes. It is recommended to perform lifelong follow-up to monitor for recurrences and complications.
本病例报告描述了一名成年女性患者罕见的科茨病病例，该患者在玻璃体内注射阿柏西普和激光光凝治疗后视力得以保留。
一名20岁的亚洲巴勒斯坦裔女性患者，在两周内左眼视力逐渐下降且无痛感。她没有其他眼部症状。就诊前，她没有明显的病史，双眼视力正常。检查左眼后段时，发现颞下毛细血管扩张、周边眼底有香肠样血管伴血管周围鞘膜、黄斑区广泛渗出、严重黄斑水肿以及局限性颞下渗出性视网膜脱离。随后，光学相干断层扫描（OCT）发现视网膜下渗出液、视网膜内和视网膜下液。在确诊为3期科茨病后，患者接受了玻璃体内注射阿柏西普（阿瓦斯汀）和扇形激光光凝治疗。第三次注射后，OCT显示视网膜内和视网膜下液消失，但视网膜下渗出液仍未消退。在上次注射一个月后，对颞下缺血区进行了荧光素眼底血管造影（FFA）引导的扇形激光光凝治疗。随后每月对患者进行监测，其视力有所改善。治疗五个月后，她的视力提高到了0.7（6/8.7），此后一直保持稳定。目前，该患者正在接受常规门诊随访。
科茨病是一种特发性、进行性疾病，主要影响男婴，但也有成人病例的报道。我们的病例和现有文献表明，在少数发生这种情况的成人病例中，视力预后良好。看来玻璃体内治疗的实施和激光使用的增加导致了更好的视觉效果。建议进行终身随访，以监测复发和并发症。
