Coats disease in adolescence and adulthood with preserved vision after laser photocoagulation monotherapy: two case reports

Abstract

Background This case report describes two rare cases of Coats disease in nonjuvenile patients with preserved vision. Case presentation Two otherwise healthy Asian males aged 15 and 29 years old presented with unilateral gradual blurred vision and scotoma, respectively. Visual acuity was 6/6 (0 logMAR) with no other abnormalities observed in the anterior segment of the eyes. Both posterior segment examinations and fluorescein angiography revealed retinal telangiectatic vessels, exudation, and hemorrhage. Additionally, optical coherence tomography of the first patient showed subfoveal fluid. Both patients were diagnosed with stage 2 Coats disease. Laser photocoagulation was performed on both patients. The first patient showed initial good response to therapy with resolution of the subfoveal fluid; however, he developed cataract and underwent cataract surgery after 3 years. In the second case, although the exudates and hemorrhage still persisted, the macula was spared and the patient did not have visual complaints. No adverse events were reported, and final visual acuity of both patients remained 6/6. Conclusions Coats disease in adolescence and adulthood may present with good vision. In mild and moderate cases of Coats disease, laser photocoagulation monotherapy may help preserve vision. Nevertheless, as recurrences and complications may still occur later in life, lifelong monitoring is recommended.

Coats’ syndrome: A rare cause of infant leukocoria to keep in mind

“…While adults typically appear with painless vision loss, children typically present with reduced vision, strabismus, nystagmus, and leukocoria [11 , 14] .…”

“…Histopathologically, subfoveal nodules are composed primarily of lipid- and protein-rich material, and they develop into macular fibrosis over time, which is linked to less favorable visual results [21] . In individuals with Coats' disease, the presence of a subfoveal nodule at presentation is a risk factor for the development of macular fibrosis and a worse visual prognosis [8 , 14] . In our case, the MRI findings of retinal detachment with T1 hyperintense, T2 hypointense subretinal fluid, smaller eye size compared to contralateral, absence of calcifications, and intraretinal macrocysts are consistent with the typical presentation of Coats’ disease.…”

“…Cryotherapy may not be able to remove retinal vascular lesions when there is bullous subretinal fluid in advanced illness or when there is substantial retinal detachment. The visual prognosis for individuals with severe disease is poor, but if they are not treated, their condition may proceed to secondary angle closure or neovascular glaucoma, which would need enucleation [15 , 14] .…”