Abstract
Purpose :
Coats disease is a nonhereditary peripheral retinal vascular disease characterized by telangiectasic vessels, microaneurysms, and exudation. Progression to retinal detachment and painful glaucoma can lead to enucleation. This study aims to assess demographic and clinical features associated with enucleation in Coats disease.
Methods :
We conducted a retrospective review of all patients diagnosed with Coats disease at a single center from November 1973 to July 2018. Demographic, clinical, and imaging characteristics of eyes requiring enucleation were compared with those of eyes that did not require enucleation using Student’s t-test and Chi-Square test. Binomial logistic regression and Kaplan-Meier analysis were used to identify factors predictive of and time to enucleation.
Results :
There were 371 eyes from 361 patients with Coats disease, of which 35 eyes of 35 patients (9.4%) were treated with enucleation. There were 27 (7.3%) eyes enucleated for neovascular glaucoma, 6 (1.6%) for concern of tumor, and 2 (0.5%) for cosmesis. Comparison of the two groups (enucleation vs. no enucleation) revealed male gender (25 (71.4%) vs. 198 (84.6%) (p=0.75)) and Caucasian race (30 (85.7%) vs. 166 (70.6%) (p=0.58)), with mean (median, range) age of (6.6 (2.3, 0-69) vs. 11.4 (5.4, 0.2-76.7) years (p=0.08)). Enucleation was associated with more quadrants of telangiectasia (p=0.001), light bulb aneurysms (p<0.001), exudation (p<0.001), and subretinal fluid (SRF) (p<0.001). On adjusted analysis, variables predictive of enucleation included presence of iris neovascularization (p=0.01), extent of light bulb aneurysms by clock hours on fluorescein angiography (p=0.01), and amount of SRF in millimeters by ultrasonography (p=0.01). Each 1 millimeter increase in SRF increased risk for enucleation by 16% (OR=1.16), and each additional clock hour of light bulb aneurysms increased the risk by 40% (OR=1.40). By Kaplan-Meier analysis, mean time to enucleation was shorter with iris neovascularization (2.4 vs. 32.7 months, p=0.01), retinal detachment by ultrasonography (10.8 vs. 143.8 months, p=0.02), and closed funnel retinal detachment (0.5 vs. 27.0 months/years, p=0.02).
Conclusions :
Clinical features that predict risk and time to enucleation in eyes with Coats disease include iris neovascularization, angiographic extent of light bulb aneurysms, millimeter elevation of SRF, and ultrasonographic retinal detachment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.