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Published on: January 7, 2018
Coats plus in prematurity
Ashley López-Cañizares1, Maria P Fernandez1, Hasenin Al-Khersan1
1Bascom Palmer Eye Institute.
Insights
Coats Plus syndrome, a rare genetic disorder, presents with varied symptoms and retinal issues. Early diagnosis and treatment, including laser photocoagulation and bevacizumab, significantly improve outcomes.
Area of Science:
- Genetics
- Ophthalmology
- Neurology
Background:
- Coats Plus syndrome (cerebroretinal microangiopathy with calcifications and cysts) is a rare, autosomal recessive disorder.
- It affects microvasculature in the retina, brain, bones, and GI system, differing from Coats disease by its bilateral nature and multi-system involvement.
Observation:
- A case report details two brothers with Coats Plus syndrome exhibiting variable phenotypes.
- One sibling initially misdiagnosed with retinopathy of prematurity, the other presented with seizures and tremors.
- Genetic confirmation of a CTC1 mutation was achieved in both patients.
Findings:
- Variable phenotypic expression is characteristic of Coats Plus syndrome.
- Aggressive treatment involving laser photocoagulation and intravitreal bevacizumab led to dramatic improvement in retinal vascular and exudative changes.
Implications:
- Coats Plus syndrome should be considered in the differential diagnosis for atypical retinal pathologies.
- Consideration is advised for conditions like retinopathy of prematurity, familial exudative vitreoretinopathy, or Coats disease with systemic abnormalities.
Background:
Coats plus syndrome or cerebroretinal microangiopathy with calcifications and cysts (CMCC) is an exceedingly rare autosomal recessive disorder that predominantly affects the microvasculature in the retina, brain, bones, and gastrointestinal system. Unlike Coats disease, CMCC is bilateral and affects multiple organ systems.
Materials And Methods:
Case report.
Results:
We report the case of two brothers with Coats Plus syndrome who presented with variable phenotypic expression. One sibling (Patient 1) was thought to have atypical retinopathy of prematurity and was only diagnosed with Coats plus after his older brother (Patient 2) presented with a seizure and a left upper extremity tremor at 4 years of age. The CTC1 mutation was confirmed in both patients. Aggressive treatment with laser photocoagulation and intravitreal bevacizumab dramatically improved the retinal vascular and exudative changes.
Conclusion:
Coats Plus syndrome can have a variable phenotypic presentation, including retinal vascular findings. This rare genetic disease should be in the differential diagnosis in patients who present with atypical retinal pathology, including Retinopathy of Prematurity, Familial Exudative Vitreoretinopathy, or Coats disease associated with non-specific multiorgan abnormalities.
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