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Yiu G, Hang A, Fong R. Surgical Drainage of Large Macular Cystoid Spaces in Coats Disease. JOURNAL OF VITREORETINAL DISEASES 2024; 8:355-358. [PMID: 38770082 PMCID: PMC11102732 DOI: 10.1177/24741264241240320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To describe an option of surgically draining large macular cystoid spaces in a patient with Coats disease. Methods: A case and its findings were analyzed. Results: A standard pars plana vitrectomy was performed to aspirate large macular cystoid spaces using a subretinal cannula with intraoperative optical coherence tomography guidance. Because of the viscous nature of the chronic fluid and lipid exudates, the contents of the large cystoid spaces were drained through a retinotomy using a soft-tipped aspiration cannula. Postoperative follow-up after surgical drainage showed immediate resolution of the macular cystoid spaces and gradual resolution of the dense subfoveal exudates over 1 year. Although surgical intervention led to the eventual resolution of the macular edema and exudates, visual recovery was limited by the chronicity of the condition. Conclusions: Surgical drainage of large macular cystoid spaces in Coats disease can be achieved in eyes that are refractory to medical management. Earlier surgical intervention in select cases may allow for visual rehabilitation.
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Affiliation(s)
- Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Abraham Hang
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Rodney Fong
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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Girolamo MM, Hadjistilianou T, Lembo A, Salvoldi F, Serafino M, Barchitta M, Menicacci C, De Francesco S, Nucci P. Unusual anterior and posterior segment features of coats disease. Eur J Ophthalmol 2024; 34:419-424. [PMID: 37439027 DOI: 10.1177/11206721231188996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE To report the clinical course and management of unusual anterior and posterior segment features of Coats disease and their relation to the age of the patients to increase the awareness towards these rare clinical features rarely described in the current literature. METHODS A retrospective descriptive review of 45 eyes of 45 patients affected by Coats disease was conducted at the Retinoblastoma Referral Center and Ophthalmology Unit of the University of Siena in Italy analyzing data from 2000 to 2022. Medical records and images were revised to find some cases presenting unusual anterior and posterior segment features in patients affected by Coats disease.We identified therefore 4 unusual clinical conditions: retinal macrocysts, anterior chamber cholesterolosis, fovea-sparing Coats disease and secondary vasoproliferative tumor. RESULTS Two patients presented with retinal macrocyst (2/45 = 4.4%), one with anterior chamber cholesterolosis (1/45 = 2.2%), two with fovea sparing Coats disease (2/45 = 4.4%) and one with vasoproliferative tumor associated (1/45 = 2.2%) for a total of six (6/45 = 13.3%) patients manifesting unusual anterior or posterior segment features in Coats disease. CONCLUSION Unusual anterior and posterior segment features of Coats disease such as retinal macrocyst and anterior chamber cholesterolosis have been more frequently reported in younger children while fovea-sparing and vasoproliferative tumors have been more commonly described in older patients. Age is then a strong prognostic marker which allows to distinguish two different phenotypes of Coats disease: patients younger and older than 3 years old with more aggressive and milder phenotype respectively.
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Affiliation(s)
- Matteo Maria Girolamo
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Theodora Hadjistilianou
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Andrea Lembo
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
| | - Federica Salvoldi
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimiliano Serafino
- Department of Neuroscience, Unit of Ophthalmology, Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo Barchitta
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cristina Menicacci
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sonia De Francesco
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
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Lee SM, Kim KH, Kang HG, Choi EY, Lee J, Kim M. Vascular abnormalities in fellow eyes of patients with unilateral coats' disease. Sci Rep 2023; 13:19380. [PMID: 37938623 PMCID: PMC10632512 DOI: 10.1038/s41598-023-45838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
Coats' disease is an idiopathic retinal vascular disorder, known to usually occur unilaterally; however, recent studies have highlighted vascular abnormalities in the fellow unaffected eyes. This retrospective study investigated the peripheral vascular features and macular vascular structure of unaffected fellow eyes in patients with unilateral Coats' disease using multimodal imaging tools. We analysed images of patients, including bilateral ultra-widefield imaging, fluorescein angiography (FA), ultra-widefield FA, or standard fundus photography. Available bilateral optical coherence tomography angiography (OCT-A) images were used for macular vascular structure analysis. OCT-A parameters, including foveal avascular zone (FAZ), perfusion index, and vessel density (VD) in the superficial and deep capillary plexuses (SCP, DCP), were calculated using Image J software. The mean age at diagnosis was 34.5 ± 17.9 years. The mean final best-corrected visual acuity of the affected eyes was logMAR 0.78 ± 0.79, while that of the fellow eyes was logMAR 0.04 ± 0.12. Ten fellow eyes had microaneurysms (47.6%), two had tortuous vessel abnormalities (9.5%), and 11(52.4%) had abnormal vascular findings on FA. Although there was a trend towards larger DCP FAZ (1.201 ± 0.086 vs. 1.072 ± 0.226), and lower DCP VD (8.593 ± 1.583 vs. 10.827 ± 3.392) in the affected eyes as measured by the Cirrus machine, the difference was not statistically significant between affected and fellow eyes when measured using the Zeiss Cirrus machine (P = 0.686, P = 0.343, respectively). However, when measured with the Spectralis machine, DCP FAZ was larger in affected eyes (0.828 ± 0.426 vs. 0.254 ± 0.092, P = 0.002) and DCP VD was lower in affected eyes (6.901 ± 2.634 vs. 17.451 ± 7.207, P = 0.002) compared to the fellow eyes, while other parameters showed no significant variations. These findings indicate that there may be subtle vascular abnormalities primarily located in the peripheral regions of the unaffected fellow eyes in patients with unilateral Coats' disease, while the macular microvasculature remains unaffected.
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Affiliation(s)
- Seung Min Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kang Hyun Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Junwon Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Ni S, Nguyen TTP, Ng R, Woodward M, Ostmo S, Jia Y, Chiang MF, Huang D, Skalet AH, Campbell JP, Jian Y. Panretinal Optical Coherence Tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:3219-3228. [PMID: 37216244 PMCID: PMC10615839 DOI: 10.1109/tmi.2023.3278269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We introduce a new concept of panoramic retinal (panretinal) optical coherence tomography (OCT) imaging system with a 140° field of view (FOV). To achieve this unprecedented FOV, a contact imaging approach was used which enabled faster, more efficient, and quantitative retinal imaging with measurement of axial eye length. The utilization of the handheld panretinal OCT imaging system could allow earlier recognition of peripheral retinal disease and prevent permanent vision loss. In addition, adequate visualization of the peripheral retina has a great potential for better understanding disease mechanisms regarding the periphery. To the best of our knowledge, the panretinal OCT imaging system presented in this manuscript has the widest FOV among all the retina OCT imaging systems and offers significant values in both clinical ophthalmology and basic vision science.
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Krivosic V, Mecê P, Dulière C, Lavia C, Zegrari S, Tadayoni R, Gaudric A. ABNORMALITIES IN THE RETINAL CAPILLARY PLEXUSES IN COATS DISEASE IN ADULTHOOD ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2023; 43:1514-1524. [PMID: 37199396 DOI: 10.1097/iae.0000000000003834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE To describe and quantify the abnormalities of the retinal capillary plexuses using optical coherence tomography angiography in Coats disease. METHODS Retrospective study. Eleven eyes of 11 patients with Coats disease (9 men and two women aged 32-80 years) compared with nine fellow eyes and 11 healthy control eyes. Horizontal bands of contiguous 3 × 3 mm optical coherence tomography angiograms of the superficial vascular plexus and deep capillary complex were acquired from the optic disk to 6 mm temporal to the fovea, through areas with telangiectasia visible on fluorescein angiography in 9 cases. RESULTS The vascular density was significantly decreased in both plexuses in eyes with Coats disease compared with normal and fellow eyes within the 6 mm temporal to the fovea (superficial vascular plexus: 21.5 vs. 29.4%, P = 0.00004 and vs. 30.3%, P = 0.00008; deep capillary complex, 16.5 vs. 23.9%, P = 0.00004 and vs. 24.7%, P = 0.00008, respectively). The fractal dimension was also significantly decreased in eyes with Coats disease (superficial vascular plexus: 1.796 vs. 1.848 P = 0.001 and vs. 1.833, P = 0.003; deep capillary complex: 1.762 vs. 1.853, P = 0.003 and vs. 1.838, P = 0.004, respectively). CONCLUSION Retinal plexuses' vascular density was decreased in Coats disease, including in areas with no visible telangiectasia.
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Affiliation(s)
- Valérie Krivosic
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, and Université Paris Cité, Paris, France
- Centre de Référence des maladies Vasculaires rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, APHP, Paris, France
- Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Pedro Mecê
- Institut Langevin, ESPCI Paris, CNRS, PSL University, Paris, France; and
| | - Cedric Dulière
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, and Université Paris Cité, Paris, France
| | - Carlo Lavia
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Samira Zegrari
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, and Université Paris Cité, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, and Université Paris Cité, Paris, France
- Centre de Référence des maladies Vasculaires rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, APHP, Paris, France
- Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Alain Gaudric
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, and Université Paris Cité, Paris, France
- Centre de Référence des maladies Vasculaires rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, APHP, Paris, France
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Vasilyeva TA, Kadyshev VV, Marakhonov AV, Kanivets IV, Korostelev SA, Koshkin PA, Pyankov DV, Petrova NV, Kutsev SI, Zinchenko RA. [Molecular genetics in diagnosis of Coats disease: combination of oligogenic variants associated with different forms of hereditary retinal dystrophy]. Vestn Oftalmol 2023; 139:69-74. [PMID: 36924516 DOI: 10.17116/oftalma202313901169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Coats disease (OMIM 300216) is a form of hereditary retinal dystrophy, which occurs due to congenital abnormality of retinal vessels and features unilateral exudative vitreoretinopathy. Coats disease mostly occurs sporadically; its genetic cause is still undetermined. Molecular genetic research including whole exome sequencing by the NGS method was used to define a genetic cause of the observed phenotype. Two heterozygous variants in different genomic loci associated with other forms of hereditary retinal dystrophy were detected, a rare variant in the HMCN1 gene c.9571C>T, p.(Arg3191Cys), and a known pathogenic variant in the NPHP4 gene c.2930C>T, p.(Thr977Met). The HMCN1 gene is responsible for dominant age-related macular degeneration (OMIM 603075), pathogenic variants in the NPHP4 gene cause recessive Senior-Løken syndrome 4 (OMIM 266900). These genes encode the proteins that are involved in the regulation of integrity of the blood-retinal barrier in the vascular endothelium (NPHP4) and retinal pigment epithelium (HMCN1). The identified mutation in the NPHP4 gene could lead to decreased function of the NPHP4 protein and contribute to the development of retinal degeneration, potentially of oligogenic nature.
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Affiliation(s)
- T A Vasilyeva
- Research Centre for Medical Genetics, Moscow, Russia
| | - V V Kadyshev
- Research Centre for Medical Genetics, Moscow, Russia
| | | | - I V Kanivets
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,OOO Genomed, Moscow, Russia
| | - S A Korostelev
- OOO Genomed, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | | | - N V Petrova
- Research Centre for Medical Genetics, Moscow, Russia
| | - S I Kutsev
- Research Centre for Medical Genetics, Moscow, Russia
| | - R A Zinchenko
- Research Centre for Medical Genetics, Moscow, Russia.,N.A. Semashko National Research Institute of Public Health, Moscow, Russia
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Clinicopathological Correlations in Enucleated Globes of Late-Stage Coats Disease with a Review of the Literature. J Epidemiol Glob Health 2022; 12:496-503. [PMID: 36175755 DOI: 10.1007/s44197-022-00068-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Coats disease may cause diagnostic dilemma because of its variable clinical presentation that can be suspicious of retinoblastoma. Late sequelae of the disease are blinding with possible enucleation. We demonstrate the main histopathological findings of Coats enucleated eyes with literature review. METHODS This was a retrospective study of all enucleated globes diagnosed as Coats disease over 30 years and were reviewed by two pathologists. The corresponding demographic data, clinical presentation, pre-operative clinical impression, and indication for enucleation were collected. Descriptive analysis of our own series data was performed. Our findings were then correlated to published data that were collected from 1983 to 2021 from the PUBMED database in English-written language. Shields classification was used as an inclusion criterion for the published reports to be analyzed. RESULTS We had seven enucleated globes with Coats disease. Mean age at presentation was 3.2 years (range 3 months to 9 years). Male predominance was observed in 6 and all cases were unilateral. Strabismus was the most common initial presentation (57%, n = 4), followed by leukocoria (43%, n = 3). Indication for enucleation was mostly suspected retinoblastoma (57%, n = 4). Four eyes were classified as stage 4, and 2 had advanced stage 5 changes. Histopathologically, subretinal fluid with lipid-laden macrophages was seen in all cases, the anterior chamber was shallow in 5/7 with angle neovascularization in 2/7. Telangiectatic vessels were clearly observed in 4/7. CONCLUSION Coats disease is a potentially visually disabling disease that is mostly unilateral in 95%, has male predominance of 81%, and wide age range with a mean of 17 years. In Saudi Arabia, the disease seems to present at younger age, tends to be more advanced, and may be indistinguishable from retinoblastoma at the time of diagnosis. Shields staging of Coats is highly recommended to be followed clinically to unify the pathways for treatment and to correlate the concluded outcomes.
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Gad M, Sen M, Shields CL. Dramatic Fluorescein Angiography in a Child. J Pediatr Ophthalmol Strabismus 2022; 59:209. [PMID: 35856430 DOI: 10.3928/01913913-20220420-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Daruich A, Zola M, Elalouf M, Munier FL. EVIDENCE AGAINST A CONTRALATERAL COATS PHENOTYPE BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2022; 42:1184-1188. [PMID: 35213527 PMCID: PMC9112948 DOI: 10.1097/iae.0000000000003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the laterality of Coats disease by analyzing optical coherence tomography angiography features in affected, fellow, and control eyes. METHODS Patients with Coats disease who underwent optical coherence tomography angiography were retrospectively reviewed. Healthy eyes of age-matched patients served as controls. Automated optical coherence tomography angiography determination of foveal avascular zone size and vascular density of superficial capillary plexus and deep capillary plexus was recorded. RESULTS Thirty-four patients with Coats disease (13 with bilateral optical coherence tomography angiography) and 24 controls were included. The foveal avascular zone was larger in affected eyes compared with fellow eyes (P = 0.004). Vascular density was decreased in affected eyes compared with fellow eyes in the superficial capillary plexus and deep capillary plexus whole images (P = 0.047 and P = 0.007) and in the deep capillary plexus at the fovea (P = 0.001). Vascular density was significantly reduced only in the deep capillary plexus in Stage 1 or 2A patients but in both plexuses in patients with Stage 2B1. No differences were shown on foveal avascular zone and vascular density values between fellow eyes of patients with Coats disease and controls. CONCLUSION The foveal avascular zone is enlarged, and vascular density is decreased in affected eyes with Coats disease, but no differences are seen between fellow and control eyes, confirming the unilateral nature of the disease.
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Affiliation(s)
- Alejandra Daruich
- Ophthalmology Department, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
- Ophthalmology Department, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; and
- INSERM, UMRS1138, Team 17, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France
| | - Marta Zola
- Ophthalmology Department, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
- INSERM, UMRS1138, Team 17, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France
| | - Martine Elalouf
- Ophthalmology Department, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Francis L. Munier
- Ophthalmology Department, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
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Alsakran WA, Nowilaty SR, Ghazi NG, Alzahrani Y, AlZaid A, Mura M, Arevalo JF, Abboud EB, Alsulaiman SM. Adjunctive Intravitreal Triamcinolone Acetonide for Exudative Retinal Detachment in Coats Disease. JOURNAL OF VITREORETINAL DISEASES 2022; 6:54-62. [PMID: 37007720 PMCID: PMC9976219 DOI: 10.1177/24741264211018957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: This work aims to assess the value of intravitreal triamcinolone acetonide (IVTA) as an adjunctive therapy in advanced Coats disease with exudative retinal detachment (ERD). Methods: A retrospective review was conducted of patients with Coats disease stage 3 or higher who received IVTA to decrease subretinal fluid (SRF), facilitate retinal ablative therapy, and avoid surgical drainage. Primary outcomes were SRF resolution and avoidance of surgical SRF drainage. Results: Seventeen eyes of 17 patients (mean, [SD] age, 3.9 [3.4] years) met the inclusion criteria. ERD configuration was bullous in 7 and shallow in 10 eyes. Following a single IVTA injection, ablative therapy was achieved after a mean (SD) of 2.1 (3.0) weeks. Complete SRF resolution was observed in 13 eyes (76.4%) after a mean of 1.3 IVTA injections and a mean of 2 (SD, 1.27) laser sessions, and none of these eyes required SRF drainage up to last follow-up (mean [SD], 50.5 [26.24] months). In 4 eyes with bullous ERD at presentation, SRF persisted ( P = .015) despite additional measures including surgical drainage. Final visual acuity ranged from 20/100 to no light perception. Cataract developed in 12 of the 17 eyes (70.5%). None developed an increase in intraocular pressure at final follow-up. Conclusions: IVTA injection can be a helpful adjunctive modality to address SRF in advanced Coats disease. It may obviate the need to surgically drain SRF to effectively treat the condition, particularly when the ERD is not highly bullous.
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Affiliation(s)
- Wael A. Alsakran
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sawsan R. Nowilaty
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nicola G. Ghazi
- Lebanese American University, School of Medicine and the Lebanese American University Medical Center, Beirut, Lebanon
| | - Yahya Alzahrani
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulrahman AlZaid
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Marco Mura
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - J. Fernando Arevalo
- The Wilmer Eye Institute, Retina Division, Johns Hopkins University, Baltimore, MD, USA
| | - Emad B. Abboud
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Barrera-Sánchez M, Martinez-Muñoz RE, Ruiz-Lozano RE, Busch C, Paez-Garza JH, Rodriguez-Valdes PJ. Coats Disease in 9 Patients: A Hispanic Case Series. Klin Monbl Augenheilkd 2021; 239:923-928. [PMID: 34911122 DOI: 10.1055/a-1658-0772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND/AIM To describe demographic and clinical characteristics, treatment, and visual prognosis of Coats disease in Hispanic patients. METHODS A retrospective chart review was performed on nine patients (ten eyes) diagnosed with Coats disease in our two clinical centrers from 2004 - 2017. RESULTS Mean age at diagnosis was 5.5 years (range 1 - 12 years) and mean follow-up time was 48 months (range 9 - 108 months). Eight patients (89%) were male and had unilateral disease and one (11%) female patient had bilateral disease. In 40% of the cases, patients were asymptomatic. Visual acuity at first presentation was worse than hand motion in 60% of the eyes. Half of the eyes (5/10 eyes, 50%) had exudative retinal detachment (≥ stage IIIA). Vascular ablation with cryotherapy combined with retinal photocoagulation was the most frequent therapeutic approach (40%). Despite anatomical success at 6 months in 100% of the treated eyes, visual outcome at 1 year of treatment was poor (worse than 20/200) in 70% of the cases. CONCLUSIONS In our case series, patients were mostly asymptomatic on presentation, with severe stages of Coats disease. Even with anatomical success after surgical treatment in all treated cases, long-term visual prognosis remained very limited.
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Affiliation(s)
| | - Rosa E Martinez-Muñoz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | - Juan Homar Paez-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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12
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Oli A, Balakrishnan D, Jalali S. Coats' disease: trends and long-term treatment outcomes in a tertiary referral centre. Ther Adv Ophthalmol 2021; 13:25158414211055957. [PMID: 34901745 PMCID: PMC8655825 DOI: 10.1177/25158414211055957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The long-term treatment outcomes in Coat’s disease – particularly in the era of newer pharmacotherapies such as anti-vascular endothelial growth factor (VEGF) agents and depot steroids – are poorly understood. Aim: To describe the clinical features and treatment outcomes of 148 eyes with Coats’ disease assessed in a referral centre over 30 years. Materials and methods: We conducted a retrospective chart review of patients diagnosed with Coats’ disease between 1 June 1987 and 31 July 2017. The demographic, clinical and treatment data were collected and long-term functional and anatomical outcomes were analysed based on the treatment either with conventional therapy (cryo/laser) or along with adjuvants like intravitreal steroids or anti-VEGFs. Results: The mean age at presentation was 15.22 years (median 11). Familial exudative vitreoretinopathy was the most common referral diagnosis, 76/148 (51.5%), followed by Coats’ disease, 37/148 (25%), and retinoblastoma, 35/148 (23.6%). Stage 3B was most common at presentation (31.8%), followed by 2B (22.3%) and 2A (16.9%). A total of 107 patients were treated either with conventional therapy or in combination with adjuvants. The mean follow-up period was 24.95 months. The visual acuity improved from baseline logMAR 2.17 (Snellen-20/2958) to logMAR 1.88 (Snellen-20/1517) at final follow-up (p = 0.004). The improvement in visual acuity was better when the presenting BCVA was <1 logMAR (Snellen 20/200), p = 0.004. No statistically significant change in BCVA was noted between conventional and adjuvant groups, p = 0.5. However, the final anatomical outcome was good in 78/99 (78.8%) in the conventional group and 45/49 (91.8%) in the adjuvant group, respectively (p = 0.046). Conclusion: In this series of patients with Coats’ disease over three decades, the use of intravitreal steroids or anti-VEGFs as adjuvants resulted in better anatomical outcomes. A better baseline visual acuity, lower stage of the disease, and older age at presentation were found to be the factors leading to favourable visual outcomes. Summary In the current series of 148 eyes with Coats’ disease, adjuvant treatment with intravitreal steroids or anti-VEGFs resulted in better outcomes as compared with conventional cryotherapy or laser photocoagulation alone. Patients with Coats’ disease who had presented with better visual acuity at baseline, lower stage of the disease and older age had better final visual outcomes.
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Affiliation(s)
| | - Divya Balakrishnan
- L V Prasad Eye Institute, Kallam Anji Reddy Campus, L. V. Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, India
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Liu JH, Deng G, Ma J, Li L, Fang Y, Li S, Lu H. Clinical Characteristics of Pediatric Coats' Disease With Retinal Cyst Using Wide-Angle Fluorescein Angiography. Front Med (Lausanne) 2021; 8:709522. [PMID: 34778282 PMCID: PMC8578680 DOI: 10.3389/fmed.2021.709522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To assess the demographic and treatment features of pediatric patients of Coats' disease with retinal cyst using wide-angle FA. Design: A retrospective, hospital based, cross-sectional study. Participants: Pediatric patients of Coats' disease underwent wide-angle FA. Methods: A retrospective review of pediatric patients of Coats' disease who underwent wide-angle FA at a single center from January 2015 to July 2020. Demographic and treatment features were compared between patients with or without retinal cyst. Main Outcome Measures: Demographic and treatment outcomes. Results: There were 123 pediatric Coats' patients in our study, and 18.70% (23/123) of the patients developed complications with retinal cyst, 73.9% (17/23) of the retinal cysts were located in the inferior-temporal quadrant and 82.6% (19/23) of the retinal cysts were located in the peripheral retina anterior to the vortex veins. Compared with patients without retinal cyst, patients with retinal cyst had more clock-hours of telangiectasia on FA (7.32 vs. 5.41, p = 0.031), and may need more total treatments (7.47 vs. 3.53, p = 0.023) including laser photocoagulation (4.08 vs. 2.31, p = 0.019) or intravitreal anti-VEGF (3.13 vs. 2.23, p = 0.039), and also required a longer time for telangiectasia resolution (22.33 vs. 18.53 months, p = 0.043). Conclusion: Pediatric patients with Coats' disease complicated by retinal cyst presented with more clock-hours of telangiectasia on FA and needed more total treatments and longer time for telangiectasia resolution.
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Affiliation(s)
- Jing-Hua Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guangda Deng
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Ma
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Li
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuxin Fang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Songfeng Li
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hai Lu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Plaza-Laguardia C, Pascual-Camps I, Bayón-Porras MR, Sánchez-Cañizal J, Gallego-Pinazo R. INTRAVITREAL RANIBIZUMAB INJECTION AND RETINAL LASER PHOTOCOAGULATION TREATMENT FOR ADULT-ONSET COATS DISEASE. Retin Cases Brief Rep 2021; 15:532-535. [PMID: 31913217 DOI: 10.1097/icb.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the evolution of a case of adult-onset Coats disease and the results of treatment with intravitreal ranibizumab and laser photocoagulation. METHODS Observational case report. CASE REPORT A 17-year-old girl presented with vision loss in her right eye (20/50) showing aneurysmatic and abnormal telangiectatic vessels associated with profuse lipid exudation and serous retinal detachment within the temporal posterior pole. The diagnosis of Coats disease was established and therapy with intravitreal injections of ranibizumab and photocoagulation was initiated achieving control of the exudative manifestations leading to restoration of visual acuity (20/20). CONCLUSION Treatment with antiangiogenic agents before laser photocoagulation may be useful for treatment of adult-onset Coats disease.
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Affiliation(s)
| | - Isabel Pascual-Camps
- Consorcio Hospital Provincial de Castellón, Spain
- Clínicas OFTALVIST, Valencia, Spain ; and
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Xu X, Essilfie J, Gong Y, Yu SQ, Freund KB. Resolution of Foveal Lipid Deposition in Adult-Onset Coats Disease With Combined Focal Laser Photocoagulation and Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina 2021; 52:396-399. [PMID: 34309430 DOI: 10.3928/23258160-20210628-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A major cause of poor visual prognosis in Coats disease is the formation of fibrovascular changes following dense foveal lipid deposition. The authors document the multimodal imaging findings of a 38-year-old woman and a 23-year-old man with adult-onset Coats disease who presented with macular edema and foveal lipid accumulation. Thermal laser targeting individual capillary macroaneurysms combined with intravitreal anti-vascular endothelial growth factor (VEGF) therapy was performed. Although there was a subsequent increase in foveal lipid immediately following the resolution of macular edema, these lipids largely resolved, leaving behind no evidence macular neovascular fibrosis. This report highlights the potential protective effect of combination therapy with thermal laser and intravitreal anti-VEGF therapy for macular exudation associated with Coats disease. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:396-399.].
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Mandura RA, Alqahtani AS. Coats' Disease Diagnosed During Adulthood. Cureus 2021; 13:e16303. [PMID: 34381658 PMCID: PMC8352457 DOI: 10.7759/cureus.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/23/2022] Open
Abstract
Coats' disease is an idiopathic non-hereditary condition first described by Coats in 1908 as a congenital retinal telangiectatic and aneurysmal disease associated with retinal exudation. Its presentation is classically in early childhood. We report a rare case of Coats' disease that first presented during adulthood in a 35-year-old male. The patient presented with visual loss in the left eye for two months. His visual acuity was counting fingers in the left eye and fundus examination revealed extensive lipid exudation in the macula with telangiectatic vessels and microaneurysms with vascular malformation in the inferotemporal quadrant. Fluorescein angiography showed leakage from the telangiectatic vessels, and optic coherence tomography showed significant macular edema. A provisional diagnosis of adult-onset Coats’ disease was made. The patient responded well to intravitreal ranibizumab injections for macular edema and sectoral argon laser photocoagulation for peripheral vascular abnormalities. This case is unusual in adulthood onset and the first presentation was during adulthood in the third decade of life in contrast to the typical age of onset which is younger than five years.
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Affiliation(s)
- Rahaf A Mandura
- Department of Ophthalmology, King Abdulaziz University, Jeddah, SAU
| | - Abdullah S Alqahtani
- Department of Ophthalmology, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, SAU
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Clinical features and prognostic factors in 71 eyes over 20 years from patients with Coats' disease in Korea. Sci Rep 2021; 11:6124. [PMID: 33731773 PMCID: PMC7969742 DOI: 10.1038/s41598-021-85739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022] Open
Abstract
This retrospective study assesses the clinical features, treatment strategies, and long-term outcomes of patients with Coats’ disease in Korea. Multimodal imaging and medical records of consecutive patients treated between July 2000 and April 2020 at two tertiary centers were evaluated based on onset age (adult vs. childhood [< 18 years]). Factors associated with final visual acuity (VA) and risk of treatment failure were assessed. A total of 71 eyes of 67 patients were included, with subgrouping by onset age showing 45% childhood and 55% adult cases. Overall, Stage 2 disease was most common at presentation (76%), though childhood cases had more Stage 3b (22% vs. 3%, P = 0.02) and greater clock hours of retinal telangiectasia (7 vs. 5, P = 0.005). First-line treatment included laser (25%), combined laser/anti-VEGF (23%), cryotherapy (20%), surgery (16%), and anti-VEGF only (9%). Cryotherapy was associated with a higher risk for secondary interventions (OR 11.8, P < 0.001), required in 56% overall. Despite a 3-line VA decrease in 34% overall, adult cases had superior final VA (P = 0.037). Multivariable regression showed that the number of anti-VEGF injections performed during the initial treatment period was associated with a 9.4 letter improvement in vision (P = 0.041). We observed a higher proportion of adult-onset Coats’ disease than previously reported in other non-Asian populations. An aggressive treatment with the addition of anti-VEGF may yield the most favorable long-term visual outcomes.
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Chwiejczak K, Biswas S, Tsamis E, Siso-Fuertes I, Kasbia S, Stanga PE. Macular fibrosis in Coats' disease demonstrated by Optical Coherence Tomography Angiography - new data toward pathophysiology. Eur J Ophthalmol 2021; 31:3157-3163. [PMID: 33426922 DOI: 10.1177/1120672120986366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze if Segmented Swept-Source Optical Coherence Tomography Angiography (SS OCT-A) can provide additional information on morphology and pathophysiology of macular fibrosis in Coats' patients. METHODS A consecutive case series of three male patients (5, 7 and 15 years old), with Coats' disease-related macular fibrosis (stage 2b-2 patients, 3b-1 patient). SS OCT-A 3×3 mm macular scans of affected eyes were performed. RESULTS In all three cases the inner portion of macular fibrosis displayed a dense network of vessels, continuing into deeper layers. This structure was similar to that observed in retinal angiomatous proliferations (RAP). There was associated loss of the foveal avascular zone. In one case we observed evolution of the lesion. CONCLUSION SS-OCT imaging of macular fibrosis in Coats' disease reveals a distinct intralesional vascular structure with elements resembling RAP, probably developing as a secondary process.
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Affiliation(s)
- Katarzyna Chwiejczak
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital & NIHR/Wellcome Trust Manchester CRF and Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Susmito Biswas
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital & NIHR/Wellcome Trust Manchester CRF and Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Evolution & Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emmanouil Tsamis
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital & NIHR/Wellcome Trust Manchester CRF and Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Irene Siso-Fuertes
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital & NIHR/Wellcome Trust Manchester CRF and Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Shakti Kasbia
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital & NIHR/Wellcome Trust Manchester CRF and Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Paulo E Stanga
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital & NIHR/Wellcome Trust Manchester CRF and Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,London Vision Clinic-Retina, London, UK
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Girolamo MM, De Francesco S, Salvoldi F, Barchitta M, Menicacci C, Hadjistilianou T. Fovea-sparing coats disease: A rare clinical entity. Eur J Ophthalmol 2020; 31:3405-3410. [PMID: 33222523 DOI: 10.1177/1120672120974289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the rarity, clinical features and management of Coats disease characterized by fovea-sparing enhancing the importance of pediatric retinal screening and early management to maintain a good visual acuity. METHODS Retrospective analysis of approximately 40 patients affected by Coats disease between 2000 and 2020 at the Retinoblastoma Referral Center and Ophthalmology unit of the University of Siena in Italy. RESULTS Two patients with fovea sparing Coats disease were included. Both presented an extrafoveal Coats disease (stage 2A by Shields classification) when they were 5 and 6 years old respectively.They had no anterior findings and a presenting visual acuity of 20/20 reflecting the early stage and a milder phenotype of the disease which are indeed more likely to be found in patients older than 3 years at presentation.Both presented telangiectasia and retinal exudation in the affected eye. Standard Argon laser photocoagulation and subsequently Cryotherapy were performed in the telangiectatic retinal periphery of both patients obtaining an excellent control and regression of the disease. CONCLUSIONS Careful pediatric retinal screening and early management are crucial to ensure a good visual prognosis in such an early feature of Coats disease as fovea sparing since this condition unfortunately tends to recall the physician's attention in more advanced stages.Due to the extremely poor number of articles regarding such a rare feature of Coats disease like fovea sparing, we report our experience.
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Affiliation(s)
- Matteo Maria Girolamo
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Sonia De Francesco
- Retinoblastoma Tertiary Referral Center, University of Siena, Siena, Italy
| | - Federica Salvoldi
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Matteo Barchitta
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Cristina Menicacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Fan KC, McAllister MA, Yannuzzi NA, Patel NA, Prakhunhungsit S, Negron CI, Capó H, Berrocal AM. X-Linked Retinoschisis and a Coats-Like Response in the Setting of Retinopathy of Prematurity. ACTA ACUST UNITED AC 2020; 4:525-529. [PMID: 34622118 DOI: 10.1177/2474126420939734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose This case report describes a unique case of a young patient with retinopathy of prematurity (ROP), a unilateral Coats-like response, and X-linked retinoschisis (XLRS). Methods A 9-year-old boy with a history of regressed ROP presented with a unilateral Coats-like response, subretinal exudation, and XLRS. Examination and imaging findings demonstrated a highly unique combination of bilateral retinoschisis and a dramatic unilateral Coats-like response with a large schisis cavity. Results Treatment with laser photocoagulation and anti-VEGF therapy led to resolution of the subretinal exudative changes. Conclusions This is the first published description to our knowledge of a patient with a Coats-like response, XLRS, and a history of regressed ROP with resolution after treatment.
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Affiliation(s)
- Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark A McAllister
- McGovern Medical School, University of Texas Houston Health Science Center, Houston, TX, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Supalert Prakhunhungsit
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Catherin I Negron
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hilda Capó
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Efficacy and Safety Outcomes of Intravitreal Dexamethasone Implant Therapy for the Treatment of Adult Coats' Disease. J Ophthalmol 2020; 2020:9131908. [PMID: 33062317 PMCID: PMC7547358 DOI: 10.1155/2020/9131908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/02/2020] [Accepted: 09/21/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the efficacy and safety outcomes of dexamethasone intravitreal implant in patients with Stage 3A Coats' disease. Methods A consecutive case series of adult Coats' disease managed with or without intravitreal dexamethasone implant (Ozurdex®, Allergan Inc., Irvine, California, USA) injection was retrospectively evaluated. The medical records of all included patients with a minimum follow-up of 6 months were reviewed. The patients were divided into two groups according to the application of dexamethasone implant as a DEX (+) group and DEX (−) group. Laser photocoagulation, anti-VEGF agents, and vitrectomy were performed if necessary. The primary outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) at month 6. Resolution of the exudative retinal detachment (ERD), subretinal fluid (SRF), and vitreous hemorrhage (VH) was also collected. Results Ten eyes (10 patients) with Stage 3A Coats' disease were included, and the mean follow-up time was 9.70 ± 4.42 months. The mean age was 44.20 ± 7.42 years, and 80% were male. Six eyes (6 patients) received intravitreal injection of Ozurdex were included in the DEX (+) group, while the other 4 eyes in the DEX (−) group. No significant difference of baseline characteristics including BCVA, CRT, IOP, and follow-up time can be defined between DEX (+) and DEX (−) groups. For the patients in the DEX (+) group, a significant improvement of BCVA was observed from the baseline of 1.28 ± 0.58 to 0.84 ± 0.66 logMAR at month 6 (P=0.03), while the CRT decreased from 970.33 ± 696.49 to 421.00 ± 275.76 μm (P=0.067). For the DEX(−) group, BCVA changed from 0.76 ± 0.74 to 0.96 ± 0.60 logMAR at month 6 (P=0.066), while the CRT from 382.75 ± 17.68 to 412.75 ± 195.53 μm (P=0.525) with no significant difference. IOP was elevated from 13.15 ± 1.74 mmHg at baseline to 18.05 ± 3.57 mmHg at month 6 with a P value of 0.02 for the DEX(+) group and from 14.48 ± 1.70 to 18.83 ± 4.06 mmHg (P=0.076) for the DEX (−) group. After a mean follow-up of 9.70 months, 5/6 (83.3%) eyes in the DEX (+) group and ¼ (25%) eye in the DEX (−) group achieved reattachment of ERD. Conclusion Intravitreal dexamethasone implant therapy is effective for adult Stage 3A Coats' disease, which provides a new treatment option for ophthalmologists.
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SUBCLINICAL MACULAR CHANGES AND DISEASE LATERALITY IN PEDIATRIC COATS DISEASE DETERMINED BY QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2020; 39:2392-2398. [PMID: 30234852 PMCID: PMC6889904 DOI: 10.1097/iae.0000000000002322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optical coherence tomography angiography quantitative data in pediatric eyes with unilateral Coats disease found significant differences in vascular density and foveal avascular zone area between disease and fellow eyes that precede clinical signs. Purpose: To determine vascular change at the macula in both eyes in unilateral pediatric Coats disease using optical coherence tomography angiography. Methods: Retrospective case-series. Thirteen eyes of pediatric patients with a diagnosis of unilateral Coats disease of various stages were compared with 13 fellow eyes. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti. Scans were analyzed with novel projection artifact removal software and improved segmentation. Vascular density and foveal avascular zone area were calculated. Results: Vascular density was significantly decreased in eyes with Coats disease in comparison with fellow eyes in both the superficial capillary plexus and deep capillary plexus (43.7 ± 4.7 vs. 45.9 ± 4.4 [P = 0.000] and 43.0 ± 6.3 vs. 50.3 ± 2.2 [P = 0.001], respectively). The difference was also significant for most sectors of the macula. Foveal avascular zone area was significantly larger in eyes with Coats disease in comparison with fellow eyes (0.29 ± 0.1 vs. 0.24 ± 0.09 [P = 0.003]). These significant differences appeared as early as Stage 2A, preceding clinical findings. Conclusion: The findings support the unilaterality of Coats disease and show that vascular changes on optical coherence tomography angiography precede clinical staging of the condition.
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Abstract
PURPOSE To evaluate microstructural retinal abnormalities on spectral domain optical coherence tomography (SD-OCT) imaging of eyes with Coats disease. METHODS This is a multicenter, retrospective study in which SD-OCT images of patients with treatment-naive Coats disease were correlated with clinical examination and visual acuity and, when available, followed longitudinally over time. RESULTS Macular SD-OCT of 27 eyes with Coats disease revealed intraretinal edema (59%), intraretinal exudates (67%), subretinal fluid (37%), subretinal exudate (48%), ellipsoid zone disruption (52%), external limiting membrane disruption (41%), and subfoveal nodule (26%). All these microstructural abnormalities correlated with worse baseline and final visual acuities (P < 0.05) on univariate analysis, except for intraretinal edema which exhibited a nonstatistically significant trend toward worse baseline visual acuity (P = 0.16). Within stage 2b eyes, external limiting membrane disruption and subretinal nodule on SD-OCT were associated with worse baseline visual acuity (P = 0.02 for both), and there was a trend toward worse final visual acuity with external limiting membrane disruption and subretinal nodule (P = 0.17 for both) and worse baseline (P = 0.08) and final (P = 0.13) visual acuities with ellipsoid zone disruption. No microstructural abnormalities were noted on OCT of fellow eyes. CONCLUSION Spectral domain OCT can identify microstructural abnormalities in Coats disease that are associated on univariate analysis with worse baseline visual acuity and visual prognosis. Further larger studies are necessary.
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Ding YH, Yao BT, Zhao XG, Yu H, Liu G, Wang XY. Refractory adult Coats disease treated with dexamethasone intravitreal implant: A case report. Medicine (Baltimore) 2020; 99:e20249. [PMID: 32443362 PMCID: PMC7254772 DOI: 10.1097/md.0000000000020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Coats disease is a sporadic, retinal vascular abnormality, causing blindness. Several interventional methods, including laser photocoagulation, have been proposed; however, the use of intravitreal dexamethasone in refractory Coats disease is not well described. PATIENT CONCERNS A 38-year-old man presented with a painless reduction in visual acuity in his right eye, commencing 15 days prior to initial assessment. DIAGNOSIS Clinical manifestations and multimodal imaging indicated Coats disease. INTERVENTIONS Retinal laser photocoagulation was performed in the nonperfused areas, 15 months later, the exudative retinal detachment, and macular edema remained, the patient was then treated with an intravitreal slow-release dexamethasone implant. OUTCOMES The exudative retinal detachment and macular edema had resolved, and the BCVA had also improved. CONCLUSION Dexamethasone intravitreal implantation was effective in treating refractory Coats disease.
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Affiliation(s)
- Yu-hua Ding
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University
| | - Bang-tao Yao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Xiao-gui Zhao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Hao Yu
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Gang Liu
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Xiu-ying Wang
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University
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Moinuddin O, Sathrasala S, Jayasundera KT, Branham KH, Chang EY, Qian CX, Recchia FM, Fahim AT, Besirli CG. Coats-like Exudative Vitreoretinopathy in Retinitis Pigmentosa: Ocular Manifestations and Treatment Outcomes. Ophthalmol Retina 2020; 5:86-96. [PMID: 32507488 DOI: 10.1016/j.oret.2020.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To provide a comprehensive review of the ocular manifestations, outcomes, and genetic findings in patients with Coats-like retinitis pigmentosa (RP). DESIGN Multicenter, retrospective, nonconsecutive case series. PARTICIPANTS Patients with a diagnosis of RP demonstrating Coats-like exudative vitreoretinopathy between January 1, 2008, and October 1, 2019. METHODS Evaluation of ocular findings at RP diagnosis and at time of presentation of Coats-like exudative vitreoretinopathy, pedigree analysis, genetic testing, retinal imaging, and anatomic outcomes after treatment. MAIN OUTCOME MEASURES Visual acuity, ophthalmoscopy results, OCT results, fluorescein angiography results, and identification of genetic mutations. RESULTS Nine patients diagnosed with RP and demonstrating Coats-like exudative vitreoretinopathy were included. Median age at time of RP diagnosis was 8 years (range, 1-22 years), and median age at presentation of Coats-like exudative vitreoretinopathy was 18 years (range, 1-41 years). Seven patients were female, and 2 were male. The genetic cause of disease was identified in 6 patients. Three patients demonstrated Coats-like fundus findings at the time of RP diagnosis. Exudative retinal detachment (ERD) localized to the infratemporal periphery was present in all patients, with bilateral disease observed in 7 patients. In all treated patients, focal laser photocoagulation was used to treat leaking telangiectasias and to limit further ERD expansion. Cystoid macular edema refractory to carbonic anhydrase inhibitor therapy and ultimately amenable to treatment with intravitreal anti-vascular endothelial growth factor injection was observed in 4 patients. CONCLUSIONS Coats-like vitreoretinopathy is present in up to 5% of all RP patients. The term Coats-like RP is used colloquially to describe this disease state, which can present at the time of RP diagnosis or, more commonly, develops late during the clinical course of patients with longstanding RP. Coats-like RP is distinct from Coats disease in that exudative pathologic features occur exclusively in the setting of a coexisting RP diagnosis, is restricted to the infratemporal retina, can affect both eyes, and does not demonstrate a male gender bias. Given the risk of added vision loss posed by exudative vitreoretinopathy in patients with RP, a heightened awareness of this condition is critical in facilitating timely intervention.
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Affiliation(s)
- Omar Moinuddin
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sanjana Sathrasala
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - K Thiran Jayasundera
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Kari H Branham
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | - Cynthia X Qian
- Retina Service, Department of Ophthalmology, University of Montreal, Montreal, Canada
| | | | - Abigail T Fahim
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Cagri G Besirli
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
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Yousef YA, ElRimawi AH, Nazzal RM, Qaroot AF, AlAref AH, Mohammad M, Abureesh O, Rejdak R, Nowomiejska K, Avitabile T, Toro MD, AlNawaiseh I. Coats' disease: characteristics, management, outcome, and scleral external drainage with anterior chamber maintainer for stage 3b disease. Medicine (Baltimore) 2020; 99:e19623. [PMID: 32311932 PMCID: PMC7220322 DOI: 10.1097/md.0000000000019623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To report on the characteristics and outcome of management of Coats' disease, and to describe a novel surgical technique for management of stage 3B with total retinal detachment (RD) by scleral external drainage with anterior chamber (AC-maintainer) placement before the drainage without pars plana vitrectomy.A retrospective study of 26 eyes from 25 Coats' patients. Outcome measures included: demographics, presentation, laterality, stage, treatment, and outcome.The median age at diagnosis was 3.5 years. Twenty patients (80%) were males, and all except 1 girl had unilateral disease. The presenting complaint was impaired vision in 13 (50%) eyes, leukocoria in 6 (23%) eyes, and strabismus in 7 (27%) eyes. Based on the Shields classification; 3(12%) eyes were stage 1, 9 (35%) eyes were stage 2, 10 (38%) eyes were stage 3, 2 (8%) eyes were stag e4, and 2 (8%) eyes were stage 5. Primary management included cryotherapy (54%), laser photocoagulation (27%), intravitreal anti-vascular endothelial growth factor (23%), intravitreal steroids (23%), and surgical drainage (12%). The 3 eyes in stage 3B (with total exudative RD) underwent subretinal fluid drainage with AC maintainer, and all had the retina reattached completely for 6 months follow up after the surgery. At mean follow up 21 months, 4 (15%) eyes were enucleated, 19 (73%) eyes had improvement or stabilization in visual acuity.Coats' disease usually presents at advanced stage with poor visual prognosis, individualized management with close follow up are mandatory to save the eye. Subretinal fluid drainage with AC maintainer is a safe and useful technique for repairing total RD in eyes with stage 3B Coats' disease.
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Affiliation(s)
- Yacoub A. Yousef
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
| | | | - Rashed M. Nazzal
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Ahmad F. Qaroot
- Department of Ophthalmology, Ibn Al-Haitham Hospital, Amman, Jordan
| | - Adnan H. AlAref
- Department of Ophthalmology, Ibn Al-Haitham Hospital, Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
| | - Omar Abureesh
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
| | - Robert Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | | | | | - Mario Damiano Toro
- Department of Neurology, Medical University of Lublin, Lublin, Poland
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszynski University, Warsow, Poland
| | - Ibrahim AlNawaiseh
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
- Department of Ophthalmology, Ibn Al-Haitham Hospital, Amman, Jordan
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Jeraq M, Armstrong V, Klimovich G, Rao KA, Byers P. Fatal gastrointestinal bleeding in a case report of Coat's plus syndrome. Int J Surg Case Rep 2019; 66:233-235. [PMID: 31874382 PMCID: PMC6931090 DOI: 10.1016/j.ijscr.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/30/2019] [Accepted: 12/04/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Coat's plus syndrome is an extremely rare genetic syndrome that leads to a variety of symptoms. We are reporting a case of Coat's plus syndrome that had persistent GI bleeding and review of current literature. PRESENTATION OF CASE The patient is a female in her 40 s with a history of coat's disease and end stage renal failure on dialysis. The etiology of renal failure was not discovered, and the patient was being worked up for a kidney transplant. The patient required admission after deterioration of nutritional status with a BMI of 14.3. During admission the patient initially had intermittent GI bleeding requiring weekly blood transfusions. On work up of the GI bleed, no etiology was identified either. As a result persistent negative GI bleed work up, we pursued alternative diagnoses. The history of Coat's disease prompted us to work up the patient for Coat's plus syndrome. A genetic test confirmed the presence of CTC-1 gene mutation, which results in Coat's plus syndrome. With no treatment available as of yet, the patient continued to deteriorate into multi-organ failure. DISCUSSION We present an example of GI bleeding in Coat's plus syndrome, only identified thru genetic testing, that is very rare and complex in nature. Despite numerous workups, no specific etiology was identified for the GI bleeding. CONCLUSION Previous reports have not investigated cause of GI bleeding, since it is extremely rare in the literature. Further investigation is warranted to understand cause and effects of GI bleeding in this rare genetic disease.
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Affiliation(s)
- Mohammed Jeraq
- Dewitt Daughtry Family Department of Surgery, Division of Trauma, Burns, and Critical Care, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Valerie Armstrong
- Dewitt Daughtry Family Department of Surgery, Division of Trauma, Burns, and Critical Care, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Grigoriy Klimovich
- Dewitt Daughtry Family Department of Surgery, Division of Trauma, Burns, and Critical Care, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Krishnamurti Amrit Rao
- Dewitt Daughtry Family Department of Surgery, Division of Trauma, Burns, and Critical Care, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Patricia Byers
- Dewitt Daughtry Family Department of Surgery, Division of Trauma, Burns, and Critical Care, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.
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28
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Petersen L, Bek T. Retinal vasodilatation in the affected eye but reduced pressure autoregulation of both eyes in unilateral Coats' disease. Acta Ophthalmol 2019; 97:679-683. [PMID: 30840364 DOI: 10.1111/aos.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 02/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coats' disease is characterized by vascular hyperpermeability, oedema and accumulation of exudates related to impairment of retinal vascular function. The background for the development of the disease is unknown, but it is likely that the study of diameter changes of retinal vessels may contribute to understanding the pathophysiology of the disease. METHODS In seven patients with unilateral Coats' disease (mean age = 34.7 years, range: 11-69 years), the baseline diameter and reactivity of retinal vessels during an increase in the arterial blood pressure by isometric exercise and in the metabolism by flicker stimulation were measured on video recordings of the retina obtained with the Dynamic Vessel Analyzer. RESULTS The baseline diameter of retinal vessels was larger in the affected than in the unaffected eyes which was significant for the arterioles (p = 0.02), but not for the venules (p = 0.15). During an increase in the arterial blood pressure induced by isometric exercise, the normal contraction of arterioles was absent in both eyes (p > 0.7), whereas there was a significant dilatation of the venules in the unaffected eyes (p = 0.04). Stimulation with flickering light induced normal dilatation of retinal vessels in both affected and unaffected eyes. CONCLUSION Unilateral Coats' disease is accompanied by vasodilatation in the affected eye but impaired pressure autoregulation in both eyes. A further investigation of the disease should include an elucidation of the background for dilatation of retinal vessels in affected eyes and whether impaired pressure autoregulation can be found in vessels elsewhere in the body.
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Affiliation(s)
- Line Petersen
- Department of Ophthalmology Aarhus University Hospital Aarhus C Denmark
| | - Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus C Denmark
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29
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Goselink RJM, Schreur V, van Kernebeek CR, Padberg GW, van der Maarel SM, van Engelen BGM, Erasmus CE, Theelen T. Ophthalmological findings in facioscapulohumeral dystrophy. Brain Commun 2019; 1:fcz023. [PMID: 32954265 PMCID: PMC7425335 DOI: 10.1093/braincomms/fcz023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022] Open
Abstract
Ophthalmological abnormalities in facioscapulohumeral dystrophy may lead to treatable vision loss, facilitate diagnostics, could help unravelling the pathophysiology and serve as biomarkers. In this study, we provide a detailed description of the ophthalmological findings in a well-defined cohort of patients with facioscapulohumeral dystrophy using state of the art retina imaging techniques. Thirty-three genetically confirmed patients (aged 7-80 years) and 24 unrelated healthy controls (aged 6-68 years) underwent clinical ophthalmological examination, fundus photography, optical coherence tomography/angiography, genotyping and neurological examination. All patients had normal corrected visual acuity and normal intraocular pressure. In 27 of the 33 patients, weakness of the orbicularis oculi was observed. Central retinal pathology, only seen in patients and not in healthy controls, included twisting (tortuosity) of the retinal arteries in 25 of the 33 patients and retinal pigment epithelium defects in 4 of the 33 patients. Asymmetrical foveal hypoplasia was present in three patients, and exudative abnormalities were observed in one patient. There was a correlation between the severity of retinal tortuosity and the D4Z4 repeat array size (R 2 = 0.44, P < 0.005). Follow-up examination in a subgroup of six patients did not show any changes after 2 years. To conclude, retinal abnormalities were frequent but almost always subclinical in patients with facioscapulohumeral dystrophy and consisted primarily of arterial tortuosity and foveal abnormalities. Retinal tortuosity was seen in the retinal arterioles and correlated with the D4Z4 repeat array size, thereby providing clinical evidence for an underlying genetic linkage between the retina and facioscapulohumeral dystrophy.
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Affiliation(s)
- Rianne J M Goselink
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen HB, The Netherlands
| | - Vivian Schreur
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen HB, The Netherlands
| | - Caroline R van Kernebeek
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen HB, The Netherlands
| | - George W Padberg
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen HB, The Netherlands
| | | | - Baziel G M van Engelen
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen HB, The Netherlands
| | - Corrie E Erasmus
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen HB, The Netherlands
| | - Thomas Theelen
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen HB, The Netherlands
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Udyaver S, Dalvin LA, Lim LAS, Mazloumi M, Atalay HT, Khoo CTL, Shields JA, Shields CL. Predictors of enucleation in Coats disease: analysis of 259 eyes of 259 patients at a single center. J AAPOS 2019; 23:266.e1-266.e9. [PMID: 31521848 DOI: 10.1016/j.jaapos.2019.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/12/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effects of clinical features associated with enucleation in eyes with Coats disease. METHODS The medical records of all patients with Coats disease at the Ocular Oncology, Wills Eye Hospital from November 1, 1973, to July 31, 2018, were reviewed retrospectively. The clinical features pertaining to need for ultimate enucleation and time to enucleation were compared. RESULTS The records of 351 eyes were reviewed, of which 259 had follow-up at our center and 32 (12%) were managed with enucleation. Reasons for enucleation included neovascular glaucoma (n = 24 [75%]), possible tumor (6 [19%]), and phthisis bulbi (2 [6%]). Compared to nonenucleated eyes, enucleated eyes had more extensive clock hour involvement of telangiectasia (P < 0.001), light bulb aneurysms (P < 0.001), exudation (P < 0.001), and subretinal fluid (P < 0.001). On adjusted analysis by binomial logistic regression, variables predictive of enucleation included presence of iris neovascularization (P = 0.01), ultrasonographic retinal detachment (P = 0.004), open-funnel retinal detachment (P = 0.04), closed-funnel retinal detachment (P = 0.01), ultrasonographic elevation of subretinal fluid by millimeters (P = 0.001), and angiographic extent of light bulb aneurysms by clock hours (P = 0.02). By Kaplan-Meier analysis of 4-year cumulative risk of enucleation, risk factors for enucleation included presence of iris neovascularization (hazard ratio [HR] 31.0; P < 0.001), ultrasonographic retinal detachment (HR 56.2; P < 0.001), open-funnel retinal detachment (HR 2.7; P = 0.01), and closed-funnel retinal detachment (HR 4.5; P < 0.001). CONCLUSIONS Clinical features that predict risk of and time to enucleation in eyes with Coats disease include iris neovascularization, ultrasonographic presence and millimeter-elevation of retinal detachment, and angiographic extent of light bulb aneurysms.
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Affiliation(s)
- Sanika Udyaver
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Li-Anne S Lim
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hatice T Atalay
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chloe T L Khoo
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Dalvin LA, Udyaver S, Lim LAS, Mazloumi M, Atalay HT, Khoo CTL, Shields CL. Coats Disease: Clinical Features and Outcomes by Age Category in 351 Cases. J Pediatr Ophthalmol Strabismus 2019; 56:288-296. [PMID: 31545862 DOI: 10.3928/01913913-20190716-01] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate features and outcomes of Coats disease by patient age. METHODS Patients with Coats disease from 1973 to 2018 were evaluated based on age category at presentation (3 years or younger vs older than 3 to 10 years vs older than 10 years). RESULTS There were 351 eyes of 351 patients with Coats disease diagnosed (2 vs 6 vs 27 years, P < .001). The youngest age group had more referral diagnoses of retinoblastoma (29% vs 15% vs 0%, P < .001), worse presenting visual acuity (< 20/200: 80% vs 67% vs 31%, P < .001), more advanced Coats disease stage (stage 3B: 65% vs 38% vs 10%, P < .001), and greater clock-hour extent of telangiectasia (7 vs 5 vs 4, P < .001), light bulb aneurysms (7 vs 4 vs 3, P < .001), exudation (10 vs 7 vs 5, P < .001), and subretinal fluid (10 vs 7 vs 4, P < .001). The oldest patients received a greater total number of treatments (3.3 vs 3.1 vs 4.4, P = .04), with more argon laser photocoagulation (37% vs 52% vs 73%, P < .001) and intravitreal anti-vascular endothelial growth factor (6% vs 9% vs 23%, P < .002) and less cryotherapy (74% vs 84% vs 58%, P < .001). At mean follow-up (70 vs 65 vs 38 months, P = .02), the youngest patients had poorer visual acuity outcome (< 20/200: 83% vs 64% vs 39%, P < .001), had less disease resolution (43% vs 65% vs 62%, P = .01), and were more likely to ultimately require enucleation (22% vs 10% vs 6%, P = .01). CONCLUSIONS Younger patients (3 years or younger) with Coats disease present with worse visual acuity and more advanced disease stage, and are more likely to require ultimate enucleation. [J Pediatr Ophthalmol Strabismus. 2019;56(5):288-296.].
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Khoo CT, Dalvin LA, Lim LAS, Mazloumi M, Atalay HT, Udyaver S, Shields JA, Shields CL. Factors Predictive of Subretinal Fluid Resolution in Coats Disease: Analysis of 177 Eyes in 177 Patients at a Single Center. Asia Pac J Ophthalmol (Phila) 2019; 8:290-297. [PMID: 31356365 PMCID: PMC6727930 DOI: 10.1097/apo.0000000000000246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to investigate factors predictive of subretinal fluid (SRF) resolution in Coats disease. DESIGN Retrospective cohort study. METHODS Institutional review board-approved review of patients diagnosed with Coats disease demonstrating SRF (stage 3-5) at a single center from November 1973 to July 2018 with comparison of eyes that had resolution of SRF to those in which SRF persisted. RESULTS There were 177 cases (154 males, 87%) of Coats disease diagnosed at a mean age of 8 years. After a mean follow-up of 62 months, SRF resolved in 110 (62%) and persisted in 67 (38%) eyes. Comparison (resolved SRF vs persistent SRF) revealed classification as stage 3A [63 (57%) vs 20 (29%)], stage 3B [47 (43%) vs 40 (60%)], or stage 4 [0 (0%) vs 7 (11%)] (P < 0.001). Eyes with resolved SRF presented with fewer clock hours of telangiectasia (mean: 5 vs 7 clock hours, P < 0.001), light bulb aneurysms (mean: 5 vs 7 clock hours, P < 0.001), exudation (mean: 7 vs 10 clock hours, P < 0.001), and extent of SRF (mean: 7 vs 10 clock hours, P < 0.001). Factors predictive of SRF resolution included absence of iris neovascularization on fluorescein angiography [odds ratio 0.05 (95% confidence interval 0.01-0.60), P = 0.02], and less elevated SRF by ultrasonography [odds ratio 0.84 (95% confidence interval 0.76-0.95), P = 0.004). For every 1-mm decrease in SRF, likelihood of SRF resolution increased by 16%. CONCLUSIONS Resolution of SRF was achieved in the majority of eyes (62%) with stage 3 to 5 Coats disease. Predictors of SRF resolution included lack of neovascularization on fluorescein angiography and less elevation of SRF by ultrasonography.
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Affiliation(s)
- Chloe T.L. Khoo
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Lauren A. Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
- Dr. Dalvin has an appointment with the Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Li-Anne S. Lim
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Hatice T. Atalay
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Sanika Udyaver
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Jerry A. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
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Shields CL, Udyaver S, Dalvin LA, Lim LAS, Atalay HT, Khoo C, Mazloumi M, Shields JA. Visual acuity outcomes in Coats disease by classification stage in 160 patients. Br J Ophthalmol 2019; 104:422-431. [PMID: 31177186 DOI: 10.1136/bjophthalmol-2019-314363] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess visual outcomes of Coats disease by classification stage. METHODS A retrospective review was conducted on consecutive patients with Coats disease, classified according to Shields classification and with available Snellen visual acuity before and after treatment. RESULTS There were 160 eyes with Coats disease (stage 1 (n=2) vs stage 2A (n=17) vs stage 2B (n=22) vs stage 3A1 (n=26) vs stage 3A2 (n=40) vs stage 3B (n=42) vs stage 4 (n=9) vs stage 5 (n=2)). By comparison, more advanced stage showed greater frequency of poor presenting visual acuity (<20/200) (0% vs 0% vs 50% vs 35% vs 38% vs 83% vs 100% vs 100%, p<0.001) and higher mean intraocular pressure (17 vs 15 vs 15 vs 15 vs 15 vs 15 vs 37 vs 26, p<0.001). More advanced stage was less likely managed with laser photocoagulation (100% vs 87% vs 48% vs 62% vs 74% vs 35% vs 0% vs 0%, p<0.001) and more likely with cryotherapy (0% vs 47% vs 81% vs 81% vs 82% vs 88% vs 50% vs 100%, p=0.001). More advanced stage was associated with lower frequency of visual acuity ≥20/40 (100% vs 71% vs 5% vs 42% vs 23% vs 5% vs 0% vs 0%, p<0.001) and greater frequency of visual acuity <20/200 (0% vs 12% vs 36% vs31 % vs 45% vs 88% vs 0% vs 100%, p<0.001). CONCLUSION Visual acuity in eyes with Coats disease parallels staging with more advanced stage demonstrating poorer visual acuity at presentation and final visit.
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Affiliation(s)
- Carol L Shields
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Sanika Udyaver
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Lauren A Dalvin
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Li-Anne S Lim
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Hatice T Atalay
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Chloe Khoo
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Mehdi Mazloumi
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jerry A Shields
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Shields CL, Udyaver S, Dalvin LA, Lim LAS, Atalay HT, L Khoo CT, Mazloumi M, Shields JA. Coats disease in 351 eyes: Analysis of features and outcomes over 45 years (by decade) at a single center. Indian J Ophthalmol 2019; 67:772-783. [PMID: 31124485 PMCID: PMC6552575 DOI: 10.4103/ijo.ijo_449_19] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/24/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess features and outcomes of Coats disease over 5-decades. Methods Retrospective review of Coats disease patients at a single center. Features and outcomes were compared based on decade of presentation. Results There were 351 patients with Coats disease. The presenting median age (6 years), male sex (84%), and unilaterality (100%) did not change per decade. Coats disease classification did not change per decade with Stage 1 (1%), Stage 2 (21%), Stage 3 (68%), Stage 4 (6%), and Stage 5 (1%). Clinical features that changed per decade (1970s vs. 1980s vs. 1990s vs. 2000s vs. 2010s) included 1980s features of more eyes with exudation in all 4 quadrants (22% vs. 58% vs. 44% vs. 33% vs. 27, P = 0.01) and total exudative retinal detachment (33% vs. 53% vs. 39% vs. 27% vs. 21%, P < 0.001). Imaging features that changed per decade included 2010s greater fluorescein angiographic extent of retinal non-perfusion in mean clock hours (4 vs. 4 vs. 3 vs. 5 vs. 6, P = 0.003), and 1980s greater mean height of retinal detachment ultrasonographically (5 vs. 12 vs. 5 vs. 5 vs. 4 mm, P < 0.001). Treatment features that changed per decade included 1980s greater primary enucleation (11% vs. 16% vs. 3% vs. 4% vs. 1%, P = 0.001), and 2010s greater use of laser photocoagulation (55% vs. 33% vs. 38% vs. 40% vs. 72%, P < 0.001), sub-Tenon corticosteroid (0% vs. 4% vs. 5% vs. 8% vs. 29%, P < 0.001), and intravitreal anti-VEGF) (0% vs. 4% vs. 2% vs. 13% vs. 18%, P = 0.003). Outcomes that changed per decade included 2010s findings of more complete resolution of subretinal fluid (64% vs. 59% vs. 38% vs. 58% vs. 72%, P = 0.01) and less need for primary/secondary enucleation (17% vs. 27% vs. 14% vs. 13% vs. 6%, P = 0.04). Conclusion Eyes with Coats disease in the 1980s demonstrated more advanced findings, often requiring enucleation. Over the decades, greater use of laser photocoagulation and injections has led to improved disease resolution with greater globe salvage.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
| | - Sanika Udyaver
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Li-Anne S Lim
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
| | - Hatice T Atalay
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
| | - Chloe T L Khoo
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14 Floor, Philadelphia, PA, USA
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Adeniran JF, Duff SM, Mimouni M, Lambert N, Ramasubramanian A. Treatment of Coats' disease: an analysis of pooled results. Int J Ophthalmol 2019; 12:668-674. [PMID: 31024824 DOI: 10.18240/ijo.2019.04.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/18/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To elucidate the association of treatment modality to vitreoretinal fibrosis and traction retinal detachment (TRD) in Coats' disease. METHODS A PubMed search for Coats' disease with included studies describing eyes with clinical features and treatment course of Coats' disease. Binary logistic regression with fibrosis at presentation and treatment type as independent variables was performed to determine predictors of TRD historically (since 1921) and in the anti-vascular endothelial growth factor (VEGF) era (since 2007). Odds ratios (OR) with 95% confidence intervals (CI) reported. RESULTS Of 175 articles described 1183 eyes. Vitreoretinal fibrosis increased from presentation (5.4%) to follow-up (15.5%) and TRD increased from 0.44% to 3.9% at follow up. Laser was protective against vitreoretinal fibrosis (OR 0.6, 95%CI 0.4-0.9) but TRD was borderline (OR 0.6, 95%CI 0.3-1.1). Cryotherapy showed a higher association with TRD (OR 1.9, 95%CI 1.0-3.7) than with vitreoretinal fibrosis (OR 0.8, 95%CI 0.5-1.2). Similarly, intravitreal anti-VEGF alone was not associated with fibrosis (OR 1.1, 95%CI 0.6-1.8) nor TRD (OR 1.1, 95%CI 0.5-2.6) but the combination of laser and anti-VEGF therapy was protective [Fibrosis: 0.1 (0.03, 0.35); TRD: 0.05 (0.01, 0.23)] compared to anti-VEGF plus cryotherapy (P<0.001). Disease stage ≤2B or ≥3A was not associated with TRD. CONCLUSION Vitreoretinal fibrosis and TRD increase after treatment in Coats' disease. The combination of anti-VEGF agents and cryotherapy may lead to higher risk for TRD. Presence of pre-treatment fibrosis is the highest risk factor for post-treatment worsening of vitreoretinal fibrosis and TRD.
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Affiliation(s)
- Janelle Fassbender Adeniran
- Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Sarah M Duff
- Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | | | | | - Aparna Ramasubramanian
- Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Ong SS, Mruthyunjaya P, Stinnett S, Vajzovic L, Toth CA. Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease. Invest Ophthalmol Vis Sci 2019; 59:3161-3174. [PMID: 30025132 PMCID: PMC6021031 DOI: 10.1167/iovs.18-24109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the association between macular features on spectral-domain optical coherence tomography (SD-OCT) and visual acuity (VA) in Coats' disease. Methods Thirty-nine eyes (39 patients) with SD-OCT from January 1, 2008 to December 31, 2016 were reviewed for SD-OCT features. Central subfield (CSF) SD-OCT findings were analyzed relative to VA (logarithm of the minimum angle of resolution) at baseline and final visit (when follow-up ≥ 6 months) and across visits. Results Mean VA ± standard deviation at baseline (37 eyes) was 0.92 ± 0.82. SD-OCT features associated with worse VA included, for treatment-naïve eyes (n = 21), outer retinal atrophy (ORA) (1.18 ± 0.34 with versus 0.20 ± 0.30 without, P = 0.005), subretinal fluid (SRF) (1.80 ± 0.63 vs. 0.63 ± 0.50, P = 0.008), bright hyperreflectivities (1.23 ± 0.68 vs. 0.52 ± 0.53, P = 0.02), thicker foveal subretinal space (r2 = 0.32, P = 0.01), and CSF (r2 = 0.39, P = 0.007); and for previously treated eyes (n = 16), a compact hyperreflective structure (1.60 ± 0.88 vs. 0.56 ± 0.64, P = 0.02) and ORA (1.34 ± 0.86 vs. 0.30 ± 0.44, P = 0.01). At final follow-up (n = 22), mean VA was 0.81 ± 0.83. Eyes with final VA <20/200 (n = 6, vs. >20/60, n = 11) more commonly had a compact hyperreflective structure and ORA at baseline and final visit (P < 0.05). Mean change in VA from baseline (n = 20) was −0.20 ± 0.59. Mean improvement in VA (range, −0.525 to −1.127) occurred in eyes with baseline SRF (P = 0.02) and bright hyperreflectivities (P = 0.03). Changes in thickness that correlated with change in VA included those for the foveal subretinal space (r2 = 0.52, P < 0.001) and CSF (r2 = 0.26, P = 0.045). Conclusions A compact hyperreflective structure (fibrosis) and ORA were associated with poor final VA while SRF, bright hyperreflectivities (exudation), and foveal subretinal thickness were associated with VA improvement post treatment.
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Affiliation(s)
- Sally S Ong
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Stanford University Medical Center, Palo Alto, California, United States
| | - Sandra Stinnett
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
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Namba M, Shiode Y, Morizane Y, Kimura S, Hosokawa M, Doi S, Toshima S, Takahashi K, Hosogi M, Fujiwara A, Shiraga F. Successful resolution of coats disease by photodynamic therapy: a case report. BMC Ophthalmol 2018; 18:264. [PMID: 30309339 PMCID: PMC6182787 DOI: 10.1186/s12886-018-0930-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coats disease is a retinal disease characterized by exudative retinal detachment due to abnormal retinal blood vessels. Coats disease is generally treated using laser photocoagulation and cryotherapy to ablate the abnormal retinal blood vessels. However, if abnormal blood vessels are present near the posterior pole of the eye and there is a severe exudative change there, it is difficult to perform these standard treatments. We describe a case of Coats disease with severe exudative retinal change and retinal vascular abnormality near the posterior pole for which we performed photodynamic therapy and successfully suppressed the disease and improved vision. CASE PRESENTATION A 15-year-old Japanese boy presented to hospital with a chief complaint of decreased vision in his right eye. At the initial examination, corrected visual acuity of the right eye was 20/100. On the right fundus, exudative retinal detachment with subretinal haemorrhage was observed from the upper intermediate periphery to the posterior pole. Abnormal telangiectatic vessels and microaneurysms were found at the nasal peripheral retina. From these findings, we diagnosed the case as Coats disease. We conducted photodynamic therapy for the right eye. At 10 months after treatment, both the subretinal haemorrhage and the exudative retinal detachment had disappeared completely. Further, the retinal structure of the macula had recovered, and right vision had improved to 20/20. CONCLUSION Photodynamic therapy may be an effective and safe treatment for Coats disease in cases that present with abnormal retinal vessels close to the posterior pole of the eye.
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Affiliation(s)
- Michie Namba
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Mio Hosokawa
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Shinichiro Doi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Shinji Toshima
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Kosuke Takahashi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Mika Hosogi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
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Saatci AO, Ayhan Z, Yaman A, Bora E, Ulgenalp A, Kavukcu S. A 12-Year-Old Girl with Bilateral Coats Disease and ABCA4 Gene Mutation. Case Rep Ophthalmol 2018; 9:375-380. [PMID: 30186147 PMCID: PMC6120373 DOI: 10.1159/000492320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/22/2018] [Indexed: 02/05/2023] Open
Abstract
A 12-year-old girl with bilateral stage 2B Coats disease was screened meticulously for a possible underlying systemic disease as she was female and the disease was bilateral. Full systemic workout turned out to be unremarkable. However, an ABCA4 gene mutation was found in the genetic analysis. NDP and TINF2 gene mutations were not present. She was successfully treated with a bilateral, single intravitreal injection of dexamethasone implant and a single session of indirect laser photocoagulation with a relatively good anatomic and functional result. To the best of our knowledge, the present case is the only reported case of Coats disease with an ABCA4 gene mutation.
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Affiliation(s)
- Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Aylin Yaman
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Elcin Bora
- Department of Clinical Genetics, Dokuz Eylul University, Izmir, Turkey
| | - Ayfer Ulgenalp
- Department of Clinical Genetics, Dokuz Eylul University, Izmir, Turkey
| | - Salih Kavukcu
- Department of Pediatrics, Dokuz Eylul University, Izmir, Turkey
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Kam AW, Hui M, Cherepanoff S, Fung AT. Rapid "epiretinal membrane" development following intravitreal bevacizumab for Coats' disease. Am J Ophthalmol Case Rep 2018; 11:75-77. [PMID: 29942874 PMCID: PMC6010952 DOI: 10.1016/j.ajoc.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of rapid "epiretinal membrane" ("ERM") development following intravitreal bevacizumab for juvenile Coats' disease. Observations A 7-year old boy was followed for four years with asymptomatic stage 2 Coats' disease in his left eye. At age 11, he developed symptomatic cystoid macular edema. Argon laser photocoagulation to the leaking aneurysms failed to improve his vision, which had symptomatically declined to 20/30. Four-months after laser, a single injection of intravitreal bevacizumab was given. Rapid development of an "ERM" was noticed on his first post-injection follow-up at 4 weeks. By 8-weeks post-injection the visual acuity had deteriorated to 20/400. 25 + gauge pars plana vitrectomy with "ERM" peeling was performed, with recovery of vision to 20/30 at the 4 months post-operative visit. Conclusions and importance Intravitreal bevacizumab may induce rapidly progressive "ERM" in patients with juvenile Coats' disease.
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Affiliation(s)
- Andrew W Kam
- Royal North Shore Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Hui
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia
| | - Svetlana Cherepanoff
- St Vincent's Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Fernandes H, Umashankar T, Richie AJ, Hegde S. Coats' disease - disease of the eye rarely encountered by pathologists. INDIAN J PATHOL MICR 2018; 61:98-100. [PMID: 29567893 DOI: 10.4103/ijpm.ijpm_826_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coats' Disease is an idiopathic condition of the eye affecting young children although it can be seen in adults. Most patients present early in life with unilateral decreased vision, strabismus or leukocoria. The most important differential diagnosis is unilateral retinoblastoma. In this study we report a case of coat's disease in an young girl, and evaluate histopathological and clinical findings.
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Affiliation(s)
- Hilda Fernandes
- Department of Pathology, Fr. Muller Medical College, Mangalore, Karnataka, India
| | - T Umashankar
- Department of Pathology, Fr. Muller Medical College, Mangalore, Karnataka, India
| | - Anto J Richie
- Department of Radiology, Fr. Muller Medical College, Mangalore, Karnataka, India
| | - Sunayana Hegde
- Department of Ophtholmology, Fr. Muller Medical College, Mangalore, Karnataka, India
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Kumar K, Raj P, Chandnani N, Agarwal A. Intravitreal dexamethasone implant with retinal photocoagulation for adult-onset Coats' disease. Int Ophthalmol 2018; 39:465-470. [PMID: 29380183 DOI: 10.1007/s10792-018-0827-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a case of adult-onset Coats' disease with secondary retinal vasoproliferative tumor managed with dexamethasone intravitreal implant and retinal photocoagulation. METHODS Case study. RESULTS A 41-year-old female with counting finger vision was diagnosed with Coats' disease with secondary retinal vasoproliferative tumor in right eye. Fundus examination revealed exudative retinopathy involving posterior pole and a retinal tumor located in the inferotemporal quadrant. Optical coherence tomography scan confirmed massive exudative neurosensory detachment and fundus fluorescein angiography showed areas of telangiectatic vessels with capillary non-perfusion. Intravitreal injection of dexamethasone implant was done initially followed by laser photocoagulation when the detachment resolved. There was significant improvement in patient's visual acuity with no further recurrence of exudation. CONCLUSION ) (Allergan, Inc., Irvine, Calif., USA) may be an effective initial therapeutic approach for Coats' disease with massive exudation.
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LONG-TERM ANATOMICAL AND FUNCTIONAL OUTCOMES FOLLOWING VITRECTOMY FOR ADVANCED COATS DISEASE. Retina 2018; 37:1757-1764. [PMID: 27984550 DOI: 10.1097/iae.0000000000001415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the long-term anatomical and functional results of vitreoretinal surgery in patients with advanced Coats disease. METHODS Retrospective analysis of 23 patients who underwent 23-gauge pars plana vitrectomy combined with transscleral cryotherapy, laser photocoagulation, and intraocular tamponade between 2005 and 2014 and had a follow-up of at least 1 year. The primary outcomes were mean visual acuity and anatomical success. RESULTS The average age at the time of surgery was 8.7 ± 1.3 years (range, 2-18 years). The mean follow-up period was 55.2 ± 31 months (range, 12-120 months). In 16 eyes (70%), further treatment was not necessary. In the remaining 7 patients (30%), revision surgery with silicone oil tamponade was required. In 20 eyes (87%), the retina was reattached. At the final visit, 8 eyes (35%) had improved mean Snellen visual acuity from 20/1,000 at initial presentation to 20/160, 3 eyes (13%) showed stabilization, and 6 eyes (26%) had decline in visual acuity. No enucleation was necessary, and no progression to neovascular glaucoma was observed. CONCLUSION Pars plana vitrectomy combined with cryotherapy, laser photocoagulation, and intraocular tamponade could be an effective treatment option for advanced Coats disease. Despite surgery, disease-related complications remained high, but the main aim of management in these young patients is functional and anatomical stability.
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RETINAL TELANGIECTASIA IN PATIENTS WITH PATHOLOGIC MYOPIA: A CASE SERIES. Retina 2017; 39:719-726. [PMID: 29232337 DOI: 10.1097/iae.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the characteristics of retinal telangiectasia in eyes with pathologic myopia. METHODS The study included 10 patients (18 eyes) who were diagnosed with pathologic myopia combined with retinal telangiectasia. The patients visited our retinal clinic every 3 months. Nine eyes underwent vitrectomy for vision-threatening complications after diagnosis. All eyes underwent comprehensive ophthalmologic examinations including multimodal retinal imaging at presentation and at each follow-up. RESULTS Retinal telangiectasia in pathologic myopia was characterized by saccular aneurysmal dilatation of the capillary bed without hard exudates in color fundus photographs and hyporeflective saccular structure in infrared reflectance fundus photographs, and it was filled in the early retinal arteriovenous phase with minimal dye leakage in the late phase of fundus fluorescein angiography. Spectral domain optical coherence tomography and optical coherence tomographic angiography showed that retinal telangiectasia was primarily located in the superficial retina, together with myopic traction maculopathy. In the 9 eyes that underwent vitrectomy, the retinal telangiectasia regressed within 3 months of surgery. Retinal telangiectasia remained stable in the other nine eyes, but these eyes were at risk of spontaneous bleeding. CONCLUSION Retinal telangiectasia is a relatively quiescent and uncommon disorder in patients with pathologic myopia that might be closely related to myopic traction maculopathy.
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Acute Angle-closure Glaucoma as a First Presentation of Coats' Disease: A Case Report. J Glaucoma 2017; 27:e33-e36. [PMID: 29176335 DOI: 10.1097/ijg.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to report an unusual first manifestation of Coats' disease presenting as an acute angle-closure glaucoma attack in an adult patient. PATIENTS AND METHODS A 37-year-old African woman presented to the emergency department with severe headache, ocular pain, and no light perception in the left eye. The left pupil was middilated and nonreactive, and the intraocular pressure (IOP) by applanation tonometry was 47 mm Hg. Slit-lamp examination revealed anterior subcapsular opacification (glaukomflecken), posterior synechiae, and total angle closure with iris bombé. A fundus examination revealed macular exudation, inferior vascular dilation, and tortuosity with peripheral telangiectasia and macroaneurysms, in addition to partial exudative retinal detachment involving the macula. On the basis of these findings, Coats' disease was diagnosed. RESULTS The patient was treated with antiglaucoma medications and laser peripheral iridotomy to control the IOP, which had decreased to 21 mm Hg the following day. Diode laser transscleral cyclophotocoagulation was performed to further decrease the IOP. After completing a 360 degree laser, the IOP decreased to 8 mm Hg and then stabilized around 12 mm Hg. The vision remained no light perception; however, the patient felt major symptomatic relief. CONCLUSIONS The present case describes acute angle-closure glaucoma as an initial presentation of Coats' disease in adults. Clinicians should be aware that this unique presentation in Coats' disease can occur even without retinal detachment.
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Peene G, Smets E, Legius E, Cassiman C. Unilateral Coats'-like disease and an intragenic deletion in the TERC gene: A case report. Ophthalmic Genet 2017; 39:247-250. [PMID: 29161159 DOI: 10.1080/13816810.2017.1401086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of a 25-year-old woman with unilateral Coats'-like disease. Her brother was previously diagnosed with an autosomal dominant form of dyskeratosis congenita. Genetic testing was performed by screening the TERC gene for mutations and identified heterozygosity for the n.68_124del mutation. Our case demonstrates that the exudative retinopathy seen in Coats'-like disease can be caused by mutations in a telomere-capping gene TERC as a part of the dyskeratosis congenita spectrum without other systemic involvement. This is an interesting case that illustrates that retinal Coats'-like involvement can be the first manifestation of dyskeratosis congenita.
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Affiliation(s)
- G Peene
- a Department of Ophthalmology , University Hospitals of Leuven , Leuven , Belgium
| | - E Smets
- b Department of Ophthalmology , University Hospitals of Antwerp , Antwerp , Belgium
| | - E Legius
- c Department of Human Genetics , University Hospitals of Leuven , Leuven , Belgium
| | - C Cassiman
- c Department of Human Genetics , University Hospitals of Leuven , Leuven , Belgium
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Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
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Kumar V, Kumar P, Garg G, Damodaran S. Vitrectomy for full-thickness macular hole in adult-onset Coats' disease. Indian J Ophthalmol 2017; 65:1246-1248. [PMID: 29133668 PMCID: PMC5700610 DOI: 10.4103/ijo.ijo_546_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/01/2017] [Indexed: 11/23/2022] Open
Abstract
The occurrence of full thickness macular hole in Coats' disease is extremely rare. The purpose of this case report is to report pars plana vitrectomy for the treatment of full thickness macular hole in a patient with adult onset Coats disease. A young male presented with decreased vision in his right eye because of full thickness macular hole. The macular hole was found to be associated with adult onset Coats' disease that was evident on ultra-wide field imaging. The patient underwent laser photocoagulation to the vascular telangiectasia followed by pars plana vitrectomy, large internal limiting membrane peeling and gas tamponade. This resulted in regression of exudation, closure of macular hole and improvement in vision. Coats disease of adult onset can present with decreased vision because of full thickness macular hole. Vitrectomy with internal limiting membrane peeling can result in excellent visual outcome.
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Affiliation(s)
- Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Garg
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Damodaran
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Rabiolo A, Marchese A, Sacconi R, Cicinelli MV, Grosso A, Querques L, Querques G, Bandello F. Refining Coats' disease by ultra-widefield imaging and optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2017; 255:1881-1890. [PMID: 28875282 DOI: 10.1007/s00417-017-3794-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The purpose of our study was to describe ultra-widefield (UWF) imaging and optical coherence tomography angiography (OCT-A) findings in affected and fellow eyes of patients with Coats' disease. METHODS Consecutive patients affected by Coats' disease were prospectively recruited at the Department of Ophthalmology, San Raffaele Hospital, Milan, Italy in this cross-sectional, observational study. Patients underwent UWF color fundus photographs, UWF green autofluorescence, UWF fluorescein angiography (FA), optical coherence tomography (OCT), with 3 × 3 mm and 6 × 6 mm OCT-A scans of the macula. Images were qualitatively evaluated by two independent operators for the presence of pathology. RESULTS Eleven patients affected by Coats' disease (eight males, mean age 17.1 ± 6.7 years). Nine and two patients had a clinical diagnosis of unilateral and bilateral disease, respectively. Five eyes had macular fibrosis. All clinically affected eyes exhibited retinal pathology at UWF imaging with the temporal sector most involved followed by the inferior, nasal, superior and macula. In all eyes with macular fibrosis, OCT-A revealed replacement of the foveal avascular zone with coarse vessels suggestive of vascularized fibrosis and flow void area in the choriocapillaris due to a masking effect; type 3 neovascularization was seen in 75% of cases. Seven out of nine clinically unaffected fellow eyes showed retinal pathology at UWF FA with the temporal quadrant most involved. CONCLUSION We demonstrated that Coats' disease is a highly asymmetric bilateral disease and that UWF imaging is able to identify more retinal pathology than standard fundus imaging, thus guiding proper retinal photocoagulation. OCT-A allowed easy identification of type 3 neovascularization in a proportion of patients with macular fibrosis.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Grosso
- Department of Ophthalmology, Santo Spirito Hospital, Casale Monferrato, Alessandria, Italy.,Centre for Macular Research, San Mauro Torinese, Turin, Italy
| | - Lea Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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Feng J, Zheng X, Li B, Jiang Y. Differences in aqueous concentrations of cytokines in paediatric and adult patients with Coats' disease. Acta Ophthalmol 2017; 95:608-612. [PMID: 27364629 DOI: 10.1111/aos.13151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/03/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the differential aqueous concentrations of vascular endothelia growth factor (VEGF) and inflammatory cytokines in paediatric and adult patients with Coats' disease. METHODS A total of 20 eyes of 20 patients with Coats' disease, 12 eyes of 12 paediatric patients, and eight eyes of eight adult patients, six patients (six eyes) with congenital cataract as the paediatric control group and 10 patients (10 eyes) with senile cataract as the adult control group were examined. Aqueous humour samples were assessed for interleukin-6, -8, -1β (IL-6, IL-8, IL-1β, respectively), basic fibroblast growth factor, monocyte chemo-attractant protein 1, tumour necrosis factor alpha and VEGF by multiplex bead assay. RESULTS Significantly, higher concentrations of VEGF, IL-6 and IL-1β were found in the paediatric patients with Coats' disease (p = 0.001, p = 0.004 and p = 0.006). Concentration of VEGF in the paediatric patients with Stage 3B of Coats' disease was significantly higher than that of Stage 3A (p = 0.010). In the adult patients with Coats' disease, the aqueous levels of IL-6 and IL-1β were significantly higher than that of the controls (p = 0.012, and p = 0.005). The concentration of IL-6 was significantly linearly associated with the extent of exudative retinal detachment (p = 0.003, R = 0.892). CONCLUSIONS Increasing severity of Coats' disease is significantly associated with intraocular VEGF concentration in the paediatric patients. And IL-6 may be involved with the inflammatory process in the adult patients with Coats' disease.
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Affiliation(s)
- Jing Feng
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; Beijing China
- Department of Ophthalmology; People's Liberation Army (PLA) Rocket Forces General Hospital; Beijing China
| | - Xiaoxue Zheng
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; Beijing China
| | - Bing Li
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; Beijing China
| | - Yanrong Jiang
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; Beijing China
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