Болезнь Коатса у взрослых пациентов: обзор литературы

В 1908 г. Д. Коатс опубликовал статью о редкой форме наружной ретинопатии с массивной экссудацией. До настоящего времени не разработано общепринятой модели патогенеза и не выявлены причины болезни Коатса (БК). Предполагалось, что причиной заболевания может быть инфекционный процесс, воспалительная реакция, но единого мнения на этот счет нет. Не найдены и генетические детерминанты развития БК. При гистологическом исследовании при БК обнаружены «холестериновые трещины», субретинальный экссудат, массивный глиоз, дезорганизация сетчатки, расширение и гиалинизация сосудов, диффузное утолщение адвентиции капилляров сетчатки и участки полного отсутствия перицитов и сосудистого эндотелия, воспалительные инфильтраты. Основной компонент субретинального экссудата — интенсивная клеточная реакция макрофагов. При исследовании цитокинового профиля отмечено повышение концентрации VEGF в субретинальной жидкости, уровень IL-6 был значительно выше у взрослых пациентов и достоверно коррелировал со степенью экссудативной отслойки сетчатки. У пациентов с БК на глазном дне выявляются сосудистые телеангиэктазии с последующим отложением экссудата в этих зонах. Из осложнений БК можно выделить вазопролиферативные новообразования, неоваскулярную глаукому, интраретинальные кровоизлияния, гемофтальм, фиброз стекловидного тела, тракционную отслойку сетчатки, холестероз передней камеры. Лечение БК включает лазерную коагуляцию, криотерапию, интравитреальное введение глюкокортикостероидов и ингибиторов ангиогенеза. При тяжелых формах и поздних стадиях БК применяется витреоретинальная хирургия. В некоторых случаях БК может быть необходима энуклеация.

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