Abstract
Purpose :
To report the presentation and clinical course of female patients with Coats’ and Coats’-like retinopathy.
Methods :
A retrospective, IRB-approved review was conducted of female patients referred to our center and diagnosed Coats’ disease between 2001-2022. Diagnosis was based on clinical and angiographic evidence. Patients lost to follow-up were excluded.
Results :
A total of thirteen eyes of eight patients were identified. Ten of 13 eyes demonstrated active disease. The median age at presentation was 19 years (range 15 months to 79 years). Three patients were found to have systemic diseases known to associate with Coats’ and Coats’-like retinopathy. Three patients presented unilaterally (OD n=1, OS n=2), whereas five patients displayed asymmetric bilateral disease. Initial corrected visual acuity varied from 20/20-2 to CF. Retinal features were classified based on the system proposed by Shields et al. The most common stage at presentation was 3A (40%), followed by 2A (30%) and 1 (30%). All patients had characteristic findings of vascular telangiectasia with both resolved (n=2) and active lesions noted in parafoveal (n=2), peripheral (n=1), temporal (n=2), superior (n=2), and inferior (n=1) regions. Lipid exudation developed in all active eyes, three of which progressed to exudative detachment as a single (n=2) and recurrent (n=1) occurrence. Light bulb aneurysms were noted in three eyes, with multiple occurrences in two eyes, separated by time and place. Localized hemorrhage was noted in seven eyes (70%) near telangiectasic and aneurysmal vessels. Treatment consisted of ablative therapy (34.5%), ablation and intravitreal bevacizumab (16.1%), ablation and intravitreal steroid injection (12.9%), intravitreal bevacizumab (6.5%), retinopexy (6.5%), vitreoretinal surgery (19.4%) and observation. Lipid resorption occurred in two eyes (20%) after 41 and 67 months. Persistent subretinal fluid was present in six eyes (60%), with recurrence after resolution occurring in two eyes (average of 5 months).
Conclusions :
Coats’ disease is uncommon and may present atypically in female patients with respect to age and clinical features, leading to a misdiagnosis. Recognizing the varying spectrum of disease is therefore imperative for early intervention and prevention of vision loss.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.