Management of lipid exudates in Coats disease by adjuvant intravitreal triamcinolone: effects and complications

Abstract

AIM To evaluate the role of intravitreal Triamcinolone (TA) in the early management of Coats disease. METHODS Retrospective, interventional case series. RESULTS 15 consecutive cases with Coats disease were managed with 4 mg/0.1 ml intravitreal TA injection on presentation and were followed for a minimum of 1 year duration. Additional management strategies including drainage of subretinal fluid through an inferior sclerotomy, peripheral laser ablation and/or cryotherapy, cataract extraction and vitrectomy were performed. Improvement of visual acuity could be achieved compared with preoperative vision in all cases in this series, even when 40% needed cataract extraction with intraocular lens implantation. One patient needed antiglaucoma treatment to control raised intraocular pressure in this series. CONCLUSIONS Triamcinolone has a role in improving the rate of absorption of subretinal fluid and macular exudates in Coats disease. The major complication of 4 mg/0.1 ml intravitreal triamcinolone is cataract in 40% of cases in children.

Role of intravitreal bevacizumab in adult onset Coats’ disease

“…Cryotherapy is preferred in lesions in the far periphery or with massive exudation [2]. IVTA [4,5] and anti-VEGF agents have been used alone [6,7] or with laser [8][9][10][11][12][13][14] primarily in children with Coats' disease to improve resorption of subretinal fluid and lipid exudates.…”

“…In addition, intravitreal triamcinolone acetonide (IVTA) has been used to reduce macular edema and subretinal exudation in Coats' disease [4,5]. Recently, it has been shown that intravitreal antivascular endothelial growth factor (VEGF) agents namely bevacizumab (Avastin Ò ; Genentech, San Francisco, CA, USA), a humanized monoclonal antibody to all isoforms of VEGF, effectively improved resorption of subretinal fluid and macular exudates when given to children with Coats' disease and may be employed alone [6,7] or with IVTA [8,9] or as adjunctive treatment to laser photocoagulation [8][9][10][11][12][13][14].…”

Diagnosis and Treatment of Coats’ Disease: A Review of the Literature

“…Recently, intravitreal triamcinolone has been found to be effective in the treatment of Coats’ disease as an adjuvant therapy [6,7,8,51,58,59]. Specifically, Othman et al [58 ]demonstrated an improvement in visual acuity, as well as absorption of subretinal fluid and macular exudates in 15 consecutive patients having been treated with intravitreal triamcinolone in combination with other treatment modalities, such as laser photocoagulation and/or cryotherapy.…”

“…Specifically, Othman et al [58 ]demonstrated an improvement in visual acuity, as well as absorption of subretinal fluid and macular exudates in 15 consecutive patients having been treated with intravitreal triamcinolone in combination with other treatment modalities, such as laser photocoagulation and/or cryotherapy. This is in line with other reports, also suggesting an improvement in visual acuity, a decrease in central retinal thickness, resolution of exudates and no recurrence at an average 6-month follow-up, in patients treated with intravitreal triamcinolone as additional therapy [6,8,51,59].…”

Efficacy and safety of dexamethasone intravitreal implant for refractory macular edema in children

“…Our study obviously does not address the question whether DEX implant is superior to IVTA, a commonly used intraocular corticosteroid that also has a 2-phase pharmacokinetic (early high concentration followed by slow release of low concentration up to 3 months). 28 The off-label use of IVTA in pediatric patients has been evaluated in retrospective series and case reports, 6,27 but no well-designed, randomized clinical trial exists to compare the efficacy, safety, and cost-effectiveness of DEX implant and IVTA in adults or children. Empirically speaking, IVTA could have been a reasonable choice to manage the cases in our series.…”