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Treatment of Coats' disease: an analysis of pooled results

International Journal of Ophthalmology(English edition) 2019年第4期12卷 668-674页

作者： Janelle Fassbender Adeniran Sarah M Duff Michael Mimouni nathan lambert Aparna Ramasubramanian Department of Ophthalmology & Visual Sciences University of Louisville School of Medicine Rambam Hospital University of Utah

AIM: To elucidate the association of treatment modality to vitreoretinal fibrosis and traction retinal detachment(TRD) in Coats' ***: A PubMed search for Coats' disease with included studies describing eyes with clinical features and treatment course of Coats' disease. Binary logistic regression with fibrosis at presentation and treatment type as independent variables was performed to determine predictors of TRD historically(since 1921) and in the antivascular endothelial growth factor(VEGF) era(since2007). Odds ratios(OR) with 95% confidence intervals(CI)***: Of 175 articles described 1183 eyes. Vitreoretinal fibrosis increased from presentation(5.4%) to follow-up(15.5%) and TRD increased from 0.44% to 3.9% at follow up. Laser was protective against vitreoretinal fibrosis(OR0.6, 95%CI 0.4-0.9) but TRD was borderline(OR 0.6, 95%CI0.3-1.1). Cryotherapy showed a higher association with TRD(OR 1.9, 95%CI 1.0-3.7) than with vitreoretinal fibrosis(OR 0.8, 95%CI 0.5-1.2). Similarly, intravitreal anti-VEGF alone was not associated with fibrosis(OR 1.1, 95%CI 0.6-1.8) nor TRD(OR 1.1, 95%CI 0.5-2.6) but the combination of laser and anti-VEGF therapy was protective [Fibrosis: 0.1(0.03, 0.35); TRD: 0.05(0.01, 0.23)] compared to anti-VEGF plus cryotherapy(P<0.001). Disease stage ≤2 B or ≥3 A was not associated with ***: Vitreoretinal fibrosis and TRD increase after treatment in Coats' disease. The combination of antiVEGF agents and cryotherapy may lead to higher risk for TRD. Presence of pre-treatment fibrosis is the highest risk factor for post-treatment worsening of vitreoretinal fibrosis and TRD.

关键词： Coats’ disease cryotherapy anti-vascular endothelial growth factor traction retinal detachment vitreoretinal fibrosis

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