Vitrectomy for epiretinal membrane in adult-onset Coats' disease

Abstract

Coats’ disease is characterized by retinal vascular telangiectasia and subretinal and intraretinal exudation. A relatively benign form of the disease that occurs in adults is referred to as adult-onset Coats’ disease. Involvement of macula in the form of macular edema and exudation are the common presenting features in both forms of the disease. We describe a rare case of adult-onset Coats’ disease that presented with epiretinal membrane (ERM). Laser photocoagulation of retinal vascular telangiectasia resulted in worsening of patient's symptoms and ERM. Early pars plana vitrectomy resulted in resolution of the patient's symptoms. Utility of ultra-wide-field imaging and rationale of early vitrectomy in such cases are discussed.

Microincision vitrectomy for secondary epiretinal membrane in adult-onset Coats’ disease

“…7 Recently, Kumar and Kumar have also reported favorable outcomes after ERM removal and ILM peeling. 6 In our case, though ILM peeling was not done, still BCVA improved to 20/20 from 20/200 after early vitrectomy and ERM removal which did not change during the 10 months follow-up period. However, few ILM folds remained on the retinal surface but parafoveal traction was completely eliminated.…”

“…2 Epiretinal membrane (ERM) is rare in Coats' disease 1,3 but can cause visual impairment in affected patients. 4,5,6 It usually develops iatrogenically after excessive treatment (treated coats' disease) like retinal photocoagulation or cryoretinopexy 7 but rarely may arise de novo (untreated Coats' disease). 4,5,6 In later cases, only a few cases of ERM have been published.…”

“…4,5,6 It usually develops iatrogenically after excessive treatment (treated coats' disease) like retinal photocoagulation or cryoretinopexy 7 but rarely may arise de novo (untreated Coats' disease). 4,5,6 In later cases, only a few cases of ERM have been published. 4,5,6 Till date, only 4 cases of adult-onset treated or untreated Coats' disease with ERM that underwent successful vitrectomy has been published [4,5,6,8].…”

“…4,5,6 In later cases, only a few cases of ERM have been published. 4,5,6 Till date, only 4 cases of adult-onset treated or untreated Coats' disease with ERM that underwent successful vitrectomy has been published [4,5,6,8]. We report a case of adult-onset Coat's disease with an ERM which was successfully treated with 25-gauge pars plana vitrectomy (25G PPV).…”

Rapid “epiretinal membrane” development following intravitreal bevacizumab for Coats' disease

“… 4 , 5 It may be precipitated by laser photocoagulation or cryotherapy, but can also occur in untreated patients. 6 , 7 The presumed pathogenesis involves chronic leakage from diseased vessels leading to reactive glial proliferation and ERM formation. ERMs may lead to traction on the retina and further accumulation of fluid in the subretinal space.…”