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Julia Sein, Jonathan Tzu, Audina M Berrocal; Treatment of Coats' disease with intravitreal bevacizumab and retinal laser photocoagulation. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):185.
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To investigate the efficacy and safety of combination treatment with laser ablation therapy and intravitreal bevacizumab (IVB) in the treatment of Coats’ disease.
Retrospective case series of pediatric patients under age 18 treated with IVB and laser ablation therapy from August 2002-January 2014. There were 21 (81%) were male and 5 were female (19%), with a mean age of presentation of 8 years (range from 2 months to 17 years). Primary outcome measures were anatomic success, globe salvage, and final visual acuity. Exclusion criteria included follow-up time of less than 6 months and prior surgical intervention.
26 patients (26 eyes) were treated with both laser photocoagulation and IVB for diagnosis of Coats’ disease. 20 patients (77%) had stage 3A2 disease with foveal involving subtotal retinal detachment, 4 patients (15%) had extrafoveal subtotal retinal detachment (stage 3A1) ,and 2 patients (8%) had stage 2A disease with extrafoveal exudation. Mean follow-up time was 2.26 years. The median number of laser applications applied was 6 (mean 5.58) and the median number of avastin injections required was 3 (mean 4.7). There was a reduction in vascular leakage and resolution of peripheral telangiectasias as well as retinal detachments in all but 2 patients. There were only two incidences of recurrence of disease. There was global salvage of all patients in the study. Ocular complications included cataracts (1 eye) and CME (1 eye) after laser photocoagulation. Vitreoretinal fibrosis was not observed in any of the patients after treatment in this study. Final visual acuity achieved in these patients was excellent; (20/20-20/50) in 5 patients, (20/60-20/100) in 4 patients, and less than 20/200 in 7 patients.
In this study of pediatric patients with Coats’ disease, intravitreal injections of bevacizumab used in combination with repetitive laser ablation therapy yielded anatomic success, global salvage, and marked improvement in visual acuity. Intravitreal bevacizumab may serve as a safe and efficacious adjunct treatment in late stages of Coats’ disease.
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