Purpose

To evaluate the long-term outcomes of treatment of total exudative retinal detachments (ERDs) secondary to Coats disease (stage 3B) and the role of vitrectomy.

Design

Retrospective, observational case series.

Participants

A total of 16 eyes in 16 patients undergoing treatment for total ERDs secondary to Coats disease with at least 5 years of follow-up.

Methods

We reviewed the records of patients with stage 3B Coats disease. The interventions, including the timing of vitrectomy if used, and clinical course were recorded.

Main Outcome Measures

The primary outcome measures were visual acuity at the most recent appointment, whether there was progression to neovascular glaucoma (NVG) or phthisis bulbi, and need for enucleation.

Results

All patients received ablative treatment (photocoagulation or cryotherapy), with 8 having scleral buckling (SB) and 6 having external drainage of subretinal fluid (XD). Of the 12 patients who had pars plana vitrectomy (PPV), 8 had early PPV (EV) in the first year after presenting, and 4 of 8 in the expectant management group had late PPV (late vitrectomy) at a mean of 4.3 years post-presentation for treatment of significant traction retinal detachment (TRD). The other 4 patients of 8 in the expectant management group did not require vitrectomy. Mean follow-up overall was 9 1/2 years. At the date of last follow-up, 50% had no light perception or light perception vision, which was consistent across the subgroups that underwent EV (4/8), late vitrectomy (2/4), or no PPV (2/4). A total of 4 of 16 patients had progression to NVG or phthisis, 1 of whom required enucleation.

Conclusions

In this retrospective series of patients with Stage 3B Coats disease, ablative therapy with a combination of PPV, XD, or SB was effective in preventing progression to NVG or phthisis in the majority of patients, thus preserving the globe. Half of the patients (4/8) in this series who did not undergo PPV in the early vitrectomy group developed late-onset TRD, suggesting a possible role for early prophylactic vitrectomy with possible SB and XD; however, this is balanced by the other half (4/8) in the expectant management group who did not require any vitrectomy.

中文翻译：

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渗出性视网膜脱离在3B期外套疾病中的长期结果

目的

评估Coats病（3B期）继发的总渗出性视网膜脱离（ERD）的治疗的长期结果以及玻璃体切割术的作用。

设计

回顾性，观察性病例系列。

参加者

在接受至少5年随访的Coats病继发总ERD治疗的16例患者中，共有16只眼。

方法

我们回顾了3B期Coats病患者的病历。记录干预措施，包括使用玻璃体切割术的时机和临床过程。

主要观察指标

主要的结局指标是最近一次就诊时的视敏度，是否进展为新生血管性青光眼（NVG）或睑板球囊炎以及是否需要摘除。

结果

所有患者均接受了消融治疗（光凝或冷冻疗法），其中8例具有巩膜屈曲（SB），6例具有视网膜下积液（XD）的外部引流。在12例行标本玻璃体切除术（PPV）的患者中，有8例在就诊后第一年出现早期PPV（EV），而预期管理组中8例中有4例在平均术后4.3年出现PPV（晚期玻璃体切除术） -治疗严重牵引性视网膜脱离（TRD）的表现。预期管理组中的其他4例患者中有8例不需要进行玻璃体切除术。总体平均随访时间为9 1/2年。在最后一次随访时，有50％的患者没有光感或光感视力，这在接受EV（4/8），玻璃体切除术（2/4）或无PPV（2/4）的亚组中是一致的）。16例患者中有4例进展为NVG或Phphiisis，

结论

在这个回顾性系列3B Coats病患者中，PPV，XD或SB联合消融治疗可有效防止大多数患者发展为NVG或Phphiisis，从而保护了地球。该系列中有一半（4/8）在早期玻璃体切除术组中未接受PPV的患者发展为晚期发病TRD，这提示可能采用SB和XD的早期玻璃体切除术可能发挥了作用。但是，这与不需要进行玻璃体切除术的预期管理组中的另一半（4/8）保持平衡。