Adjunctive Intravitreal Triamcinolone Acetonide for Exudative Retinal Detachment in Coats Disease

Abstract

Purpose: This work aims to assess the value of intravitreal triamcinolone acetonide (IVTA) as an adjunctive therapy in advanced Coats disease with exudative retinal detachment (ERD). Methods: A retrospective review was conducted of patients with Coats disease stage 3 or higher who received IVTA to decrease subretinal fluid (SRF), facilitate retinal ablative therapy, and avoid surgical drainage. Primary outcomes were SRF resolution and avoidance of surgical SRF drainage. Results: Seventeen eyes of 17 patients (mean, [SD] age, 3.9 [3.4] years) met the inclusion criteria. ERD configuration was bullous in 7 and shallow in 10 eyes. Following a single IVTA injection, ablative therapy was achieved after a mean (SD) of 2.1 (3.0) weeks. Complete SRF resolution was observed in 13 eyes (76.4%) after a mean of 1.3 IVTA injections and a mean of 2 (SD, 1.27) laser sessions, and none of these eyes required SRF drainage up to last follow-up (mean [SD], 50.5 [26.24] months). In 4 eyes with bullous ERD at presentation, SRF persisted ( P = .015) despite additional measures including surgical drainage. Final visual acuity ranged from 20/100 to no light perception. Cataract developed in 12 of the 17 eyes (70.5%). None developed an increase in intraocular pressure at final follow-up. Conclusions: IVTA injection can be a helpful adjunctive modality to address SRF in advanced Coats disease. It may obviate the need to surgically drain SRF to effectively treat the condition, particularly when the ERD is not highly bullous.

Coats Plus Syndrome in a Premature Infant, With a Focus on Management

“…Laser photocoagulation is the main constant of the many different treatment paradigms for Coats plus syndrome and FEVR. 3,7,9,12…”

“…Laser photocoagulation is the main constant of the many different treatment paradigms for Coats plus syndrome and FEVR. 3,7,9,12 In some cases, however, significant exudative RD prevents the use of a laser. Although extensive cryotherapy is a thermal substitute for laser treatment, inflammation can exacerbate SRF and exudation.…”

“…Steroids reduce inflammation but also destabilize VEGF mRNA. 13 In a recent case series, 12 17 eyes of 17 patients with Coats disease and exudative RD were treated only with IVT triamcinolone acetonide with subsequent ablative therapy in an attempt to avoid surgical intervention. Of the eyes, 76% had complete SRF resolution.…”