Coats病の治療成績

Therapeutic outcome of Coats' disease

　われわれは当科で最近10年間にCoats病20例20眼を経験した．半数が10歳以下の若年者で，男性は女性の3倍多く，全例片眼発症であった．白色瞳孔を主訴としたのは5歳以下の乳幼児で，網膜芽細胞腫との鑑別を要したのが1眼あった．異常血管病巣が1象限以内のものは5眼，1〜2象限は6眼，2象限以上におよんだのは9眼であった．網膜血管の異常部への直接的光凝固（キセノン，アルゴン，クリプトン，色素レーザー）を18眼に行い，症例により，輪状締結術や硝子体手術を追加し，14眼77％が治癒した．とくに眼底病変が2象限以内の症例の治療成績は100％と良好であり，2象限以上に広がった症例の治癒率は44％であった．また自覚症状発現から治療開始までの期間が7カ月以上のものは，治療成績が良くなかった．治療としては光凝固が有効であるが，病巣が2象限以上に広がったものは難治であることが示された．

We observed 20 cases of Coats' disease during a 10-year period through 1987. The condition was unilateral in all the cases. The series comprised 15 males and 5 females. Nine cases were under 10 years of age, 4 in the second decade, 5 in the third decade and 2 were over 30 years of age. All the 5 eyes aged 4 years or less manifested leukocoria.

We treated 18 eyes with photocoagulation, using xenon, argon, krypton or dye laser. Following treat-ment, 14 eyes (77%) responded with decrease of subretinal exudates and exudative retinal detach-ment. Improvement in visual acuity occurred in 6 of17 eyes (35%). Persistent subretinal or preretinal fibrosis, macular atrophy or cystoid macular edema was responsible for the generally unfavorable visual outcome. Funduscopic improvement resulted in all of 11 eyes in which retinal telangiectasia involved two quandrants or less. Improvement in visual acuity was possible only when treated within 6 months after initial signs of the disease. The findings suggest that early photocoagulation is the treatment of choice for Coats' disease. Cases with telangiectasia involving less than 2 quandrants promise more favorable therapeutic outcome.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(12) : 1373-1377, 1988