Schmidt-Erfurth U, Lucke K
Augenklinik der Medizinischen Universität, Lübeck, Germany.
Ger J Ophthalmol. 1995 Jan;4(1):32-6.
Massive subretinal exudates as well as vitreal traction often induce complicated retinal detachments in patients with advanced Coats' disease. If left untreated, most patients experience secondary glaucoma by rubeosis and phthisis bulbi in addition to irreversible visual loss. We report on the surgical procedures used and results obtained in three patients aged between 21 and 28 years with combined exudative and traction-induced detachment. In all cases, extensive but unsuccessful retinal coagulation had been performed. The surgical intervention was done by application of an encircling buckle followed by vitrectomy and removal of preretinal membranes and subretinal lipid exudates via retinectomies. Particular attention was paid to the intensive endodiathermy of retinal teleangiectasies during surgery. Surgery was concluded by siliconeoil tamponade. Postoperatively, progressive resorption of remaining exudates and teleangiectatic vessels could be observed. All patients demonstrated stable functional and anatomic results at the last follow-up examination performed at 13 months to 6 years after surgery. A stabilization of the anatomic and functional situation can be achieved even in advanced cases of Coats'-induced traction retinal detachment by vitreoretinal surgery.
大量视网膜下渗出物以及玻璃体牵拉常导致晚期科茨病患者发生复杂性视网膜脱离。若不治疗，大多数患者除了不可逆转的视力丧失外，还会因虹膜红变和眼球痨继发青光眼。我们报告了3例年龄在21至28岁之间、合并渗出性和牵拉性视网膜脱离患者所采用的手术方法及取得的结果。所有病例均曾进行广泛但未成功的视网膜凝固术。手术干预包括应用环扎带，随后进行玻璃体切除术，并通过视网膜切除术切除视网膜前膜和视网膜下脂质渗出物。手术期间特别注意对视网膜毛细血管扩张症进行强化透热疗法。手术最后行硅油填充。术后可观察到残留渗出物和毛细血管扩张血管逐渐吸收。在术后13个月至6年进行的最后一次随访检查中，所有患者的功能和解剖结果均稳定。即使是科茨病所致牵拉性视网膜脱离的晚期病例，通过玻璃体视网膜手术也可实现解剖和功能状况的稳定。
