成人Coats病诊治进展

摘要

Adult Coats disease is characterized by abnormal expansion of retinal capillaries,often accompanied by massive lipid exudation and exudative retinal detachment.Unlike Coats disease in young children,adult Coats disease is mostly limited to peripheral retina,with slow progress and better prognosis.Adult Coats disease should be identified with Coats-like diseases such as exudative age-related macular degeneration,diabetic retinopathy,obsolete retinal vein occlusion,idiopathic macular telangiectasia 1,obsolete posterior uveitis,retinal vasculitis,or acute retinal necrosis.Because the pathogenesis of Coats disease is not clear,it lacks specific treatment measures for the cause of disease.The purpose of simple or combined laser photocoagulation,freezing,vitreous intravitreal injection against vascular endothelial growth factor drugs or triamcinolone and surgery is to eliminate abnormal blood vessels and exudation,maintain visual function,which can also improve retinal detachment and prevent neovascular glaucoma and other complications.To explore the similarities and differences of adult Coats disease with Coats disease in young children,to further promote the study of the pathogenesis of adult Coats disease and to provide new targets for its treatment are the direction of future research.%成人Coats病以视网膜毛细血管和微血管异常扩张为特征,常伴大量脂质渗出和渗出性视网膜脱离.与青少年儿童Coats病有所不同,成人Coats病病变多局限于周边部视网膜、进展缓慢、视力预后较好.成人Coats病需与渗出型老年性黄斑变性、糖尿病视网膜病变、陈旧性视网膜静脉阻塞、特发性黄斑旁毛细血管扩张症1型、陈旧性后葡萄膜炎、视网膜血管炎或急性视网膜坏死等Coats样病变相鉴别.由于Coats病的发病机制尚不明确,故缺乏针对病因的特异性治疗措施;单纯或联合激光光凝、冷冻、玻璃体腔注射抗血管内皮生长因子药物或曲安奈德及手术等临床常用方法的治疗目的是消除异常血管和渗出、维持视功能、改善视网膜脱离和防止新生血管性青光眼等并发症.探究成人Coats病与青少年儿童Coats病的异同,进一步推进成人Coats病发病机制的研究,为其治疗提供新的靶点是今后研究的方向.