目的 观察青少年Coats病的眼底表现、治疗效果及随诊情况.方法 回顾性系列病例研究.收集:1962至2006年,经眼底检查和荧光素眼底血管造影确诊为Coats病的24例(26只眼)患者临床资料进行分析.患者初诊年龄1～18岁,平均7岁;男件18例,女性6例;双眼2例(均为女性),单眼22例;10只右眼,16只左眼.根据患者眼底病情给予激光光凝、冷凝或联合玻璃体切除术治疗.随访时间1～44年,平均5年.结果 在26只患眼中,眼底有毛细血管扩张、视网膜动脉瘤、无灌注区及黄斑渗出者7只眼;合并有渗出性视网膜脱离者15只眼;晚期病变已无光感或濒于失明者4只眼.共有21只眼行激光治疗,10只眼眼底渗出和出血吸收,视网膜复位,视力增进,其中6只眼视力在0.8以上;共计10只眼行玻璃体切除术,其中6只眼曾行激光治疗,2只眼外加冷凝治疗,术后视力最佳为0.1.在治疗后的随诊中,有5例眼底又出现新的病变,及时补充激光治疗,保持了较好视力.24只眼中,有10只眼(42%)视力增加,12只眼(50%)视力未改变,2只眼(8%)视力减退.结论 青少年Coats病的病灶在周边,渗出性病变多累及黄斑部.若早期发现并及时予以激光治疗,患者预后视力较好,但需长期随诊,随访中如发现新病变需补充激光治疗.%Objective To investigate retrospectively the clinical manifestation and the final visual prognosis through a long-term fellow-up study. Methods It was retrospective case series study. Twenty four patients (26 eyes ) were diagnosed with Coats disease from 1962 through 2006 at the Department of Ophthalmology, Peking Union Medical Hospital, Chinese Academy of Medical Sciences. Age, visual acuity,time of initial visit, method of treatment and the condition of eye fundus for each patient were documented.The time of follow-up ranged from 1- 44 years, averaged 5 years. Results Age of the patients at initial visit ranged between 1 to 18 years old, 7 years on average. Eighteen patients (75%)were male and 6 were female (25%). Twenty two cases were unilateral and only 2 female patients were bilateral. In 26 eyes, 7 eyes exhibited capillary irregular dilatation, miliary aneurysms and nonperfusion area on fluorescein angiography located at peripheral fundus; 15 eyes were complicated with exudative retinal detachment. Four eyes reached end stage with no light perception or only finger count. Laser photocoagulation was performed in 21 eyes. In 10 eyes, retinal exudates and hemorrhages were absorbed with improvement of visual acuity. Ten eyes with extensive retinal detachment including macula underwent closed vitrectomy, the best visual acuity was 0.1 after surgery. Conclusions The onset of Coats disease is in early young childhood. Abnormal vascular lesions and military aneurysms appeared at peripheral fundus with early retinal exudation involving the macula. Early treatment with laser coagulation could obtain good visual prognosis. The supplement treatment is required for new lesions occurring during the long- term follow-up period.
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