Treatment of Coats’ disease: an analysis of pooled results

Adeniran, Janelle Fassbender; Duff, Sarah Madison; Lambert, Nathan G.; Ramasubramanian, Aparna

doi:10.18240/ijo.2019.04.23

Cited by 7 publications

(7 citation statements)

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“…Macular fibrosis in Coats disease includes preretinal fibrosis, vitreoretinal fibrosis, epiretinal membrane [ 6 , 7 ], extramacular fibrosis [ 3 ], and subfoveal nodules [ 8 ], which can occur from the anterior retina to the sub-retina. Although macular fibrosis is observed in only 2% patients with Coats disease at initial presentation [ 9 ], it occurs in 23%–40% patients treated with intravitreal bevacizumab, photocoagulation, and cryotherapy during follow-up [ 3 , 5 , 7 , 10 ]. Macular fibrosis due to intraretinal neovascularization leads to poor visual prognosis due to retinal layers involvement [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of a case of Coats disease in a 10-year-old boy with spontaneous peeling of preretinal macular fibrosis: a case report

et al. 2022

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Background Coats disease is a retinal vascular disorder characterized by aneurysms and telangiectasias. Macular fibrosis is a complication of Coats disease that results in vision loss. Macular fibrosis rarely develops in the natural course and often occurs after treatment with intravitreal bevacizumab, photocoagulation, or cryotherapy. Here, we have described an unusual case of spontaneous peeling of preretinal macular fibrosis in a patient with untreated Coats disease. Case presentation A 10-year-old Japanese boy presented with vision loss in his left eye. The patient’s left visual acuity was 20/28. Fundus examination of his left eye revealed thick preretinal macular fibrosis around the optic disc and macula. In addition, retinal telangiectasis, microaneurysms, hard exudates, and retinal hemorrhages were observed in the left peripheral temporal retina. We diagnosed his condition as Coats disease with preretinal macular fibrosis. Two months later, optical coherence tomography revealed preretinal macular fibrosis detachment at the foveal lesion without any treatment. During follow-up, preretinal macular fibrosis at the macular lesion was completely detached. Further, posterior vitreous detachment was observed and the shape of the macula and the patient’s left visual acuity had improved. Conclusions In our case, both formation and spontaneous peeling of preretinal macular fibrosis occurred without any treatment for Coats disease, which is an unusual finding. Vitreous changes might have occurred during the natural clinical course, causing subsequent posterior vitreous detachment and resulting in spontaneous peeling of fibrosis.

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Section: Discussionmentioning

confidence: 99%

Long-term follow-up of a case of Coats disease in a 10-year-old boy with spontaneous peeling of preretinal macular fibrosis: a case report

et al. 2022

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“…This is probably owing to the rarity of the condition, suboptimal retrospective reporting, heterogeneity in patients’ characteristics and disease stage, varying therapeutic combinations, timing, and follow-up intervals, and unclear outcomes definition in the different reports. 7 Future well-designed prospective studies – possibly through a global collaboration network – with pre-defined outcomes would be ideal.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 3 However, the optimum therapeutic modality – or combination of modalities – remains controversial with variable reports in the literature depicting inconsistent results. 7 …”

Section: Introductionmentioning

confidence: 99%

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Experience with Intravitreal Ranibizumab as an Adjunct to Ablation Therapy in Eyes with Exudative Coats’ Disease

Nowara¹,

Fouad²,

Aziz³

et al. 2021

OPTH

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Background Coats’ disease is a rare entity with retinal vascular telangiectasia that can progress to exudative retinal detachment, neovascular glaucoma, and a blind painful eye requiring enucleation. Despite recent therapeutic advances decreasing the need for enucleation, no consensus exists about the optimum management of exudative Coats’ disease. The use of intravitreal anti-vascular endothelial growth factor agents as an adjunct to ablation therapy has been shown to achieve favorable outcomes, but some reports suggest an increased incidence of vitreoretinal (VR) fibrosis and tractional retinal detachment (TRD). Methods We retrospectively reviewed records of patients presenting with exudative Coats’ disease (stages 2 and 3) from April 2016 till November 2020. Extracted data included clinical and radiological assessment, stage (Shields’ classification), interventions, and follow-up. Results Sixteen eyes were included in the final analysis, of which 4 (25%) were stage 2 and 12 (75%) were stage 3. All eyes underwent intravitreal ranibizumab injection combined with ablation therapy, 14 (87.5%) underwent cryotherapy, 4 (25%) underwent laser ablation, 3 (18.75%) underwent external subretinal fluid drainage, and 3 (18.75%) underwent buckle or vitrectomy surgery. After a median follow-up of 16 months, 11 eyes (68.75%) had complete resolution, 4 (25%) had incomplete resolution, and only one (6.25%) progressed but did not require enucleation. Three eyes (18.75%) developed VR fibrosis, but none progressed to TRD. Conclusion Combining intravitreal ranibizumab injection with ablation therapy is effective in managing exudative Coats’ disease. External drainage should be preserved for when ablation therapy is not feasible. Future prospective trials with pre-defined outcomes are required.

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“…[13][14][15] The risk of hyaloidal contraction evolving into tractional retinal detachment exists with intravitreal antivascular endothelial growth factor use. [16][17][18] Intravitreal triamcinolone may enhance the absorption of SRF and exudates, but it is associated with complications like cataract in as many as 40% of cases and secondary glaucoma in 6% of cases. 19 In cases with complex retinal detachment and extensive exudation, pars plana vitrectomy with or without tamponade has been attempted and reported to be effective.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Advanced Coats Disease in 32 Eyes: A 20-Year Study

Rishi

Attiku

et al. 2020

Journal of VitreoRetinal Diseases

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Purpose: This work studies outcomes of external subretinal fluid (SRF) drainage in management of eyes with advanced Coats disease. Methods: Patients with advanced-stage Coats disease (≥stage 3B), who were younger than 12 years and underwent external SRF drainage from 1996 to 2016, were included in this retrospective study. Surgical intervention involved external drainage of SRF and cryotherapy. SRF drainage was performed by lamellar scleral dissection or by external needle drainage. Favorable anatomical outcome was defined as retinal reattachment with normal intraocular pressure (IOP). IOP greater than 24 mm Hg was considered raised. Univariate and multivariate analyses were performed to measure the association between preoperative or intraoperative factors and retinal status at final follow-up. Outcome measures evaluated included visual acuity, IOP, retinal status, globe status, and complications of surgery. Kaplan-Meier analysis was performed for globe salvage without pain. Results: Thirty-two eyes of 32 patients were included in the study. Mean age at surgery was 3.8 ± 3 years. The mean duration of follow-up was 7 years (range, 6 months-15.7 years). Improvement in visual acuity was seen in 5 eyes. Retina was attached at final visit in 6 eyes. IOP in the range of 8 to 24 mm Hg was noted in 16 eyes. Favorable anatomical outcome was achieved in 3 (9%) eyes. Globe salvage was achieved in 84% of eyes. Complications included intraoperative vitreous hemorrhage (n = 1) and postoperative inflammation (n = 1). Kaplan-Meier ocular survival rate without pain at 10 years was 76%. Conclusions: SRF drainage and cryotherapy in eyes with advanced Coats disease favorably alter the natural history of the disease and prevent end-stage complications. Visual outcomes remain poor.

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Treatment of Coats’ disease: an analysis of pooled results

Cited by 7 publications

References 50 publications

Long-term follow-up of a case of Coats disease in a 10-year-old boy with spontaneous peeling of preretinal macular fibrosis: a case report

Long-term follow-up of a case of Coats disease in a 10-year-old boy with spontaneous peeling of preretinal macular fibrosis: a case report

Experience with Intravitreal Ranibizumab as an Adjunct to Ablation Therapy in Eyes with Exudative Coats’ Disease

Surgical Management of Advanced Coats Disease in 32 Eyes: A 20-Year Study

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