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Sally S Ong, Lejla Vajzovic, Prithvi Mruthyunjaya; Treatment of early and intermediate stage Coats Disease: a 20 year review. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4464.
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© ARVO (1962-2015); The Authors (2016-present)
Coats disease is a retinal vascular disease characterized by vascular telangiectasias, lipid exudation and exudative retinal detachment requiring varied treatments. This study reviews treatment choices for early and intermediate stage Coats disease.
An IRB-approved, retrospective, single institution review of patients diagnosed with clinical and/or angiographic signs of Coats disease from 1995 to 2015. Eyes were classified as early [group E] (stages 1, 2A, and 2B) or intermediate [group I] (3A or 3B) stage. Visual acuity and treatments were compared between groups. Eyes with advanced (stages 4 or 5) were excluded.
A total of 38 eyes from 35 patients were included with median age of 4.6 years (range 0 to 42 years). There were 14 (37%) group E and 24 (63%) group I eyes. Median age at presentation was 4.6 and 4.5 years, respectively. Median initial visual acuity was 20/30 (range 20/20 to 20/400) and light perception (20/30 to NLP) respectively. Treatments for group E eyes included ablative therapies [laser photocoagulation and cryotherapy] (79%) or ablation with intravitreal bevacizumab (20%) while group I eyes had ablation (13%), ablation with intravitreal bevacizumab (17%), vitreoretinal surgery (38%) or enucleation (5%). Median final visual acuity was 20/40 and light perception in groups E and I eyes, respectively. Interestingly, subset analysis showed that while most group I treatment groups had worsening of median visual acuity from the initial to the final visit, the group treated with ablation and intravitreal bevacizumab demonstrated an exception to the trend (n=3, median visual acuity improved from 20/400 at the initial visit to 20/50 at the final visit).
Treatment for early and intermediate stage Coats disease over a 20 year period has progressed to include intravitreal anti-VEGF therapy. Intermediate, compared to early stage eyes present with worse visual acuity and often require vitreoretinal surgical intervention for disease control. Multiple interventions are often utilized but overall stabilization of visual acuity can be difficult especially in intermediate Coats disease eyes. However, the intermediate stage eyes that were treated with ablation and intravitreal bevacizumab with good visual outcomes suggest that this treatment approach can be effective for a subset of eyes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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