Coats' Disease-Related Macular Edema Treated with Combined Aflibercept and Laser Photocoagulation

Three-Year Results of Management of Adult-Onset Coats' Disease by Possibly Targeting Placental Growth Factor

We report long-term results of treatment with intravitreal injection of aflibercept in a newly diagnosed case of adult-onset Coats' disease. A 40-year-old Philipino male was referred to our Eye Center complaining of vision reduction for the past three months in his right eye. Examination revealed visual acuity of 0.1 in the affected right eye with normal vision of 1.0 in his left eye. Fundal examination of the right eye showed temporal retinal telangiectasia with massive exudation reaching the macula. The left fundal examination was normal. The patient’s optical coherence tomography (OCT) demonstrated massive exudative thickening. The patient was managed with one intravitreal injection of aflibercept followed by focal laser, with successful anatomical and subjective outcomes that were maintained after three years. Aflibercept's profile targeting both vascular endothelial growth factor (VEGF) and placental growth factor seems to show favorable outcomes when compared to other purely anti-VEGF treatment options. We therefore believe that aflibercept is an excellent adjunctive therapy in cases of adult-onset Coats’ disease with macular edema. To our knowledge, this is the first case treated with laser and intravitreal aflibercept with a long three-year follow-up suggesting the significant role of aflibercept in vascular permeability and supporting its use as a valuable therapeutic option for Coats’ disease.

Advanced Coats' disease treated with intravitreal brolucizumab combined with laser photocoagulation

Purpose

To report the first use the intravitreal anti-VEGF brolucizumab for the treatment of macular exudates and edema in a patient with Coats’ disease.

Observations

A 9-year-old boy was referred with a decrease in vision in the right eye. Visual acuity was 20/400 OD on presentation, and examination was remarkable for peripheral telangiectasias, exudates, microaneurysms, macular edema, and an inferior exudative retinal detachment. A diagnosis of Stage 3A2 Coats’ disease was made, and the patient was treated with intravitreal bevacizumab as well as peripheral diode laser. However, on follow up, there was persistence of subretinal fluid accompanied by a decrease in visual acuity. The patient was then treated with intravitreal brolucizumab. Post injection visual and anatomical improvements were significant with complete resolution of macular edema within two weeks. Throughout the 5 months of follow up, there has been no re-accumulation of fluid and no further required therapy.

Conclusions and Importance

Intravitreal brolucizumab was effective for the treatment of retinal edema and exudates in Coats’ disease.

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Intravitreal brolucizumab may be used in select pediatric patients with positive outcomes.

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Patients with Coats' disease may benefit from the efficacy of intravitreal brolucizumab.

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Intravitreal brolucizumab combined with laser photocoagulation can be effective for advanced Coats disease.

Recent advances in the diagnosis and treatment of Coats' disease

PURPOSE

To review and summarize the recent progress in the diagnosis and treatment of Coats' disease.

METHODS

Literature was collected from Web of Science, Medline and Pubmed, through searching of these keywords: "Coats' disease", "diagnosis" and "treatment".

RESULTS

Coats' disease is characterized by idiopathic leaky retinal vascular telangiectasia and microvascular abnormalities often accompanied by intraretinal or subretinal exudation and retinal detachment. Neovascular glaucoma and phthisis bulbi often occur in advanced cases. Coats' disease has significant diversity in terms of its clinical presentation and morphology. Anti-VEGF therapy combined with laser photocoagulation for early Coats' disease and anti-VEGF therapy combined with minimally invasive vitrectomy for advanced Coats' disease can achieve good efficacy.

CONCLUSION

Early diagnosis and timely treatment based on clinical stage are critical to retaining the patient's visual function. Patients should be aware that close long-term follow-up is necessary.