Purchase this article with an account.
C. Jandeck, U. Kellner, H. Heimann, M.H. Foerster; Coats Disease in Children Under 16 Years of Age Between 1991–2004 . Invest. Ophthalmol. Vis. Sci. 2005;46(13):675.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose:The purpose of this study was to evaluate the anatomical outcome and describe the clinical variations in Coats disease in children under 16 years of age treated in a tertiary eye care center. Patients & Methods: In this retrospective, consecutive study Coats disease was defined as idiopathic retinal teleangiectasia with intraretinal or subretinal exudation. Thirty–four patients (35 eyes) under 16 years of age were included. The retinal changes were classified according to the classification proposed by Shields et al 2001. Coagulation treatment or surgery was performed in all but one eye. Anatomical and functional results were obtained over 3 months – 13 years (median 21 months) of follow–up. Results:Coats disease was diagnosed in our department at a median of 4.8 years (4 months – 14 years); occurring in 27 males (79%) and unilaterally in 34 children (97%). The retinal changes were classified into five stages. Stage 1 was not observed in our series. Stage 2 occurred in 18 eyes, stage 3a in 2 eyes and stage 3b in 8 eyes. Stage 4 was recognised in 8 eyes and stage 5 in 1 eye. In all eyes with stage 2 or 3a, only coagulation treatment was necessary. In 4/8 eyes with stage 3b, primary vitrectomy was performed. 7/8 eyes with stage 4 were enucleated. In 16 children the initial symptoms were strabismus, and leukocoria in 6 cases. Diagnosis and treatment was delayed for more than 2 months (median 5.8 months) in 24 children (71%) because of prior misdiagnosis by their paediatrician or primary eye specialist. The interval between the first reported symptoms and treatment was, for stage 2, 1.2 months, for stage 3, 10.5 months and stage 4, 19.4 months. Final visual acuity was, light perception, in 10 eyes only, in 6 eyes, 20/200 and in 7 eyes >= 20/40. All eyes with stage 2 and 3a and all but one eye with stage 3b could be saved.Conclusions:Due to coagulation treatment in stages (1–3b) 26/27 eyes could be saved. 6/7 eyes (86%) with Coats disease stage 4 needed to be enucleated due to pain or severe anterior and posterior pathology without the possibility of ruling out retinoblastoma. Vascular changes with exudates could be successfully treated with early coagulation treatment. A delay in diagnosis has an impact on the stage of treatment as defined by Coats and therefore on the final outcome.
This PDF is available to Subscribers Only