Abstract
Purpose :
Surgical options for advanced Coats’ and Coats’-like detachments are limited and outcomes unpredictable. We describe a surgical technique and its anatomic outcomes for total retinal detachment in advanced Coats’ disease and Coats-like exudative retinal detachment associated with facioscapulohumeral muscular dystrophy (FSHD).
Methods :
This was a retrospective, consecutive interventional surgical case series of six eyes of five patients with stage 4 Coats’ Disease and Coats’-like exudative detachment associated with FSHD who underwent combined 20 or 23G pars plana vitrectomy, endolaser, and encircling scleral buckle (PPV/EL/SB) by a single surgeon at our institution between 2010-2016. We reviewed patients’ medical records, intraoperative color fundus photography and angiography to determine rate of retinal reattachment and leakage pre- and post procedure. Herein, we describe the surgical technique and long-term clinical outcomes.
Results :
Of the 6 eyes, 2 (33.3%) had FSHD. Average age was 4.1 years (1.2-9.1) with mean follow-up of 37.8 months (1.4-137). Of 6 eyes undergoing an initial PPV/EL/SB, 5 (83.3%) received concurrent perfluorocarbon and external drainage, two (33.3%) received silicone oil (SO), and two (33%) received anti-vascular endothelial growth factor (anti-VEGF) at initial surgery.
At the final visit, all eyes exhibited macular attachment and 4 eyes (66.7%) had >50% total retinal attachment. Both FSHD eyes required a second vitrectomy with SO placement for recurrent retinal detachments. There were no recurrent total detachments requiring surgery in the Coats’-only group. All six eyes underwent subsequent green argon laser treatment with an average of 2.4 treatments (range, 1-4) during the follow up period for postoperative leakage. One eye (16.7%) developed glaucoma requiring cyclocryophotocoagulation. One FSHD eye developed an iatrogenic break at initial surgery, and one Coats’ only eye developed a peripheral stretch break without proliferative vitreoretinopathy which was observed at final visit.
Conclusions :
Combined PPV/EL/SB may be a potential surgical option in achieving initial anatomic attachment in challenging Coats’ and Coats’-like total detachments associated with FSHD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.