Vitrectomy techniques in late-stage Coats'-like exudative retinal detachment

Abstract

Retinal telangiectasia is the hallmark of Coats' disease. In the late stages, leakage from these abnormal vessels can result in a total, bullous exudative retinal detachment with cholesterol-laden subretinal fluid. Secondary angle-closure glaucoma may result in a blind and painful eye which may require enucleation or evisceration. Surgical reattachment of the retina and destruction of the retinal telangiectasia may preserve these eyes. We have found that vitrectomy, internal drainage of subretinal fluid and cholesterol, direct treatment of the retinal telangiectasia with intraocular diathermy and intravitreal gas or silicone oil injection are effective surgical techniques for salvaging these severely damaged eyes.

Observations on the management of Coats' disease: less is more

“…3 15 16 Several authors have reported more invasive techniques, including vitrectomy, posterior retinotomy, use of intraocular silicone or gas, and scleral buckling. [17][18][19] Visual and anatomical outcomes are disappointing with these more complex and invasive techniques. We feel that this is a situation where less is more.…”

The Management of “Coats' Response” in a Patient with X-Linked Retinitis Pigmentosa—A Case Report

“…Endolaser, however, produced good results. Yoshizumi et al observed similar findings in one advanced exudative case managed with external drainage and attempted cryotherapy then subsequent laser photocoagulation [3]. They suggest that retained cholesterol deposits insulated the retinal telangectasia preventing freezing.…”

“…In advanced cases (stages 3 and 4), the focus of management shifts from preserving vision to preserving a painless eye. In these cases, the conventional wisdom has been to perform vitrectomy, scleral buckling cryotherapy, and drainage of the exudate via either a retinotomy or external drain [3]. …”

Advanced Coats’ disease successfully managed with vitreo-retinal surgery

“…Yoshizumi et al 5 reported success in three out of four patients with advanced Coats' disease or Coats'-like reaction after vitrectomy surgery. All three successful operations included internal air-fluid exchange and one unsuccessful operation did not include internal air-fluid exchange.…”