Cataract development in children with Coats disease: risk factors and outcome

To describe the clinical features of cataract during the course of Coats disease and to determine its risk factors and effects on the long-term visual outcome.

The medical records of consecutive patients with Coats disease followed for at least 2 years were analyzed retrospectively. Ophthalmological examination, ancillary tests, and treatment modalities were reviewed. The time of cataract diagnosis and its management were recorded. Parameters influencing cataract development and final visual outcome were investigated using uni- and multivariate analysis.

A total of 57 patients (mean age, 5.0 ± 4.0 years; 51 males) were included; cataract formation was observed in 16 (28%) during a mean follow-up of 7.1 ± 3.7 years. The mean time from diagnosis of Coats disease to cataract detection was 25 ± 22 months. Total white cataract developed in 12 patients (75%); posterior subcapsular cataract, in 4 (25%). Cataracts were surgically removed in 10 patients to improve fundus visualization and clinical follow-up. Presence of exudative retinal detachment at diagnosis was an independent risk factor for cataract formation (P = 0.031). Cataract development was associated with more advanced disease stages (P < 0.001). History of cataract was a significant predictor for worse final visual outcome (P < 0.001), independent of disease stage (P = 0.003) and presence of macular complication, such as atrophy, fibrosis, or tractional retinal detachment (P < 0.001, adjusted R² = 0.83).

Cataract development is frequent in children with Coats disease and aggravates the visual prognosis. Exudative retinal detachment at diagnosis, present in more advanced disease stages, is an independent risk factor for cataract formation.