Intravitreal ranibizumab in the management of stage 2B Coats disease in a young adult Malay man

INTRAVITREAL RANIBIZUMAB INJECTION AND RETINAL LASER PHOTOCOAGULATION TREATMENT FOR ADULT-ONSET COATS DISEASE

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.

Treatment of Coats' disease: an analysis of pooled results

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.