单侧Coats病的临床特征和治疗结果-一项全球合作研究

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2025-06-01 DOI:10.1016/j.oret.2024.11.017

Andrew S.H. Tsai MBBS, FRCOphth , Chung-Ting Wang MD , Thomas C. Lee MD , Aaron Nagiel MD, PhD , Kate Matsunaga BA , C. Armitage Harper III MD , Edward H. Wood MD, FASRS , Sang Jin Kim MD, PhD , Sungsoon Hwang MD, PhD , Michael J. Shapiro MD , Michael P. Blair MD , Cynthia A. Toth MD , Nita Valikodath MD, MS , Maria Ana Martinez-Castellanos MD , Matthew G.J. Trese DO , Antonio Capone Jr. MD , Kimberly Drenser MD, PhD , Zujaja Tauqeer MD, PhD , Cagri G. Besirli MD, PhD , Emily Eton MD , Wei-Chi Wu MD, PhD

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引用次数: 0

摘要

目的：探讨抗vegf治疗时代单侧Coats病的临床结局及影响预后的因素。设计：全球、多中心、回顾性病例系列。受试者：656例Coats病患者的656只眼纳入本研究。排除标准为视网膜色素变性继发Coats病和双侧病例。方法：收集全球20家眼科科茨病患者的临床资料。我们比较了早期（1-2期）和晚期（3-5期）Coats病的临床特征和治疗方式。主要结局指标：功能结局包括视力（VA）达到0.3 logMAR或更高，VA改善或稳定。解剖失败被定义为发展为肺结核，慢性视网膜脱离，大量纤维化，或需要去核。结果：早期患者的平均年龄为17.4±17.8岁，而晚期患者的平均年龄为7.1±7.1岁（p < 0.001）。男性在早期和晚期均占优势（84.7%）。晚期疾病与较高的斜视发生率（20.2%对6.7%,p < 0.001）和白斑发生率（12.3%对3.2%,p < 0.001）相关。更多的早期疾病患者接受激光光凝单药治疗（44.7%比21.1%,p < 0.001）。此外，早期疾病接受玻璃体内抗vegf注射作为辅助治疗的次数更多（4.4±6.2比2.7±2.1,p = 0.005）。与较差的功能结果相关的因素包括较差的表现视力、较晚的疾病阶段和存在中央凹结节。较差的表现视力和较晚的疾病阶段与解剖成功的可能性较低相关，而联合治疗增加了解剖成功的可能性。结论：单侧Coats病以男性为主，与疾病分期无关。鉴别中央凹结节对视力预后至关重要。激光光凝仍然是主要的治疗方法。虽然抗vegf可以预防去核，但其在早期疾病中的作用需要进一步阐明。

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Clinical Characteristics and Treatment Outcomes in Unilateral Coats Disease

Purpose

To evaluate the clinical outcomes and prognostic factors in unilateral Coats disease in the era of anti-VEGF therapy.

Design

Global, multicenter, retrospective case series.

Subjects

Six hundred fifty-six eyes of 656 subjects with Coats disease were included in this study. Exclusion criteria were Coats disease secondary to retinitis pigmentosa as well as bilateral cases.

Methods

Clinical data from patients with Coats disease were collected from 20 ophthalmic practices around the world. We compared early-stage (stage 1–2) and advanced-stage (stage 3–5) Coats disease in terms of clinical characteristics and treatment modalities.

Main Outcome Measures

Functional outcomes include achieving visual acuity (VA) of 0.3 logarithm of the minimum angle of resolution or better and VA improvement or stability. Anatomical failure was defined as the development of phthisis, chronic retinal detachment, massive fibrosis, or the requirement for enucleation.

Results

Subjects with early-stage disease were significantly older, with a mean age of 17.4 ± 17.8 years, compared with 7.1 ± 7.1 years in the advanced-stage group (P < 0.001). There was a male predominance in both early and advanced stages (84.7%). Advanced disease was associated with a higher incidence of strabismus (20.2% vs. 6.7%, P < 0.001) and leukocoria (12.3% vs. 3.2%, P < 0.001). More subjects with early-stage disease received laser photocoagulation as monotherapy (44.7% vs. 21.1%, P < 0.001). Additionally, early-stage disease received more sessions of intravitreal anti-VEGF injections as adjunct therapy (4.4 ± 6.2 vs. 2.7 ± 2.1, P = 0.005). Factors associated with poorer functional outcomes included worse presenting VA, advanced disease stage, and the presence of a foveal nodule. Worse presenting VA and advanced disease stage were associated with lower likelihood of anatomical success, whereas combination therapy increased the odds of anatomical success.

Conclusions

Unilateral Coats disease predominantly affects males, regardless of disease stage. Identifying a foveal nodule is crucial for visual prognosis. Laser photocoagulation remains the primary treatment. Although anti-VEGF may prevent enucleation, its role in early-stage disease requires further clarification.