Role of intravitreal bevacizumab in adult onset Coats’ disease

Abstract

To evaluate the role of intravitreal bevacizumab in the treatment of Coats' disease diagnosed in adulthood. Prospective, interventional case series. Three patients with Coats' disease diagnosed in adulthood were managed with a single intravitreal injection of bevacizumab (1.25 mg) with peripheral laser photocoagulation 3 weeks later. All three patients had exudation at the macula (Stage 2B) along with peripheral retinal telangiectasia and aneurysms. They were followed up for 9 months. An appreciable reduction in the exudation at the macula and macular edema was observed in all cases following intravitreal bevacizumab therapy. In all patients, the visual acuity improved, and no signs of recurrence were observed at the final follow-up at 9 months. Intravitreal bevacizumab injections may be effective as an adjunctive treatment for adult-onset Coats' disease with foveal exudation along with laser photocoagulation to the peripheral retinal vascular abnormalities. Intravitreal bevacizumab was well tolerated by our patients, and no adverse effects were observed.

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

“…81,82 There are several reports of successful treatment of Coats' disease with intravitreal bevacizumab alone or in combination with other treatment modalities. [83][84][85] However, the patients treated with intravitreal bevacizumab are at risk for vitreoretinal fibrosis and TRD despite resolution of the retinopathy. 85 Intraocular injection of bevacizumab has been reported to cause rapid regression of anterior segment neovascularization in the eyes with neovascular glaucoma.…”

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

“…Coats’ disease is a mostly unilateral, progressive condition affecting mainly males during childhood, with the average age of diagnosis being between 8 and 16 years, although several cases have also been reported in adults [4,5,6,7,8,9,10,11]. It is often described as ‘light bulb telangiectasia’ due to the large amounts of yellow exudates accompanying the condition [5].…”

“…The results of intravitreal injections of anti-VEGF agents have been reported in few case reports and small case series and have been variable, as is depicted in table 3 [7,8,9,10,11,47,48,59,60,61,62,63,64,65,66,67,68,69]. Kaul et al [64] recommend it as a future adjunctive treatment alongside traditional therapies, in accordance with the majority of other authors, as it seems to reduce macular oedema and exudates, improve or even stabilize visual acuity and enhance the regression of dilated abnormal vessels [7,8,9,10,11,47,48,59,60,61,62,63,65,66,67,68,69]. On the contrary, Ramasubramanian et al [69] suggested that bevacizumab should be used with caution, as vitreoretinal fibrosis and, potentially, traction retinal detachment were found in patients treated with bevacizumab in addition to standard therapy, but not in patients receiving only standard measures.…”

Intravitreal Bevacizumab as an adjunct to laser in the management of adult onset Coats’ disease

“…While the optimal time period is unclear, in our series, laser was performed 3 weeks following the injection, as a decrease in macular edema was evident by this time [2]. Also, the recurrences in macular edema following initial therapy have not been elaborated.…”

“…We read with interest the article BIntravitreal bevacizumab injections combined with laser photocoagulation for adultonset Coats' disease^by Park S et al [1] We were both surprised and disappointed to notice that the authors had completely missed our case series of three patients titled BRole of intravitreal bevacizumab in adult onset Coats' disease^published in 2011 [2] on the very same subject. In fact, this was the first report on successful use of intravitreal Bevacizumab (IVB) combined with laser photocoagulation in treating patients with adult onset Coats' disease; prior to this, there was only a single case report on use of IVB for this condition [3].…”