ABSTRACT
Retinopathy ofprematurity,familial exudative vitreoretinopathy and Coats disease are the most common neonates and infants retinal vascular diseases,which may lead to severe visual damage because of either tractional retinal detachment caused by the proliferation of pathogenic neovascularization,or exudative retinal detachment due to the extremely leakage from abnormal retinal vessels.Classic treatment is retinal laser photocoagulation which could destroy these abnormal vessels or reduce non vascular areas to diminish the growth of new vessels,however the side effects induced by laser it self such as visual field damage,hemorrhage,retinal tear,fail to control the progression of the disease make the laser treatment hard to improve the vision of these young patients.Anti-vascular endothelial growth factor (VEGF) agents have been widely applied in various adult retinal and choroidal vascular diseases,they are even possible to replace the pan retinal photocoagulation in proliferative diabetic retinopathy,while there are still many unsolved problems in the applying in neonates and infants retinal vascular diseases,like dosage,timing,retreatment and systemic side effects.We should realize the importance of selecting the laser photocoagulation and anti-VEGF for neonates and infants retinal vascular diseases.
ABSTRACT
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.
ABSTRACT
Objective To observe the efficacy of adjuvant intravitreal injection of anti-vascular endothelial growth factor (VEGF) therapy for advanced Coats disease.Methods This study is a retrospective case series study.Fourteen patients (14 eyes),presenting Coats Stages 3B and 4 (8 and 6 eyes,respectively) were enrolled.All the patients were treated with adjuvant intravitreal anti-VEGF therapy.The intravitreal anti-VEGF injections varied from 1 to 7,with a median injections of 2.14.In 14 eyes,combined therapy was subretinal fluid drainage in 4 eyes,photocoagulation in 2 eyes,vitrectomy in 8 eyes.The follow-up period was ranged from 4 to 36 months,with a median follow-up of 18.8 months.Visual acuity and retinal reattachment were observed in follow up.Results At last follow up,global suvival was 100.0％ with no enucleation performed in any patient because of disease progression.Except for 2 children who were unable to cope with the visual acuity test,visual acuity was improved in 2 patients,stable in 8 patients,and decreased in 2 patients.5 patients (35.7％) achieved in complete retinal reattachment,3 patients (21.4％) were succeed in partial retinal reattachment,and the remain 6 patients(42.8％) failed in retinal reattachment.Two patients developed cataract after vitrectomy,and no other adverse reaction was observed during follow-up.Conclusion Anti-VEGF therapy combined with classic treatments in advanced Coats disease can keep or impove the visual acuity in most patients by reducing of subretinal exudation.
