Targeted Multimodality Treatment to Eliminate the Need for Enucleation in Advanced Coats Disease

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Retinal Diseases

Background:

• Coats disease is a rare idiopathic retinal vascular anomaly.
• Advanced stages (3 and 4) present significant challenges in management and visual prognosis.
• Traditional treatments have limitations in achieving optimal outcomes.

Purpose of the Study:

• To evaluate a staged therapeutic approach for advanced Coats disease.
• To assess the impact of transpupillary laser vascular ablation, intravitreal bevacizumab, and posterior sub-Tenon triamcinolone acetonide on globe retention, anatomic status, and visual acuity.
• To analyze treatment trends and outcomes from 2005 to 2023.

Main Methods:

• Retrospective review of 68 patients treated between 2005 and 2023.
• Analysis of literature case series and novel cases of advanced Coats disease (stage 3 and 4).
• Treatment involved transpupillary laser vascular ablation, intravitreal (IVT) bevacizumab, and as-needed posterior sub-Tenon triamcinolone acetonide for persistent exudation.

Main Results:

• Complete resolution of retinal detachment in all patients.
• No neovascular glaucoma or endophthalmitis observed post-treatment.
• At 24 months, visual acuity outcomes included: 42% better than 20/50, 39% better than 20/400, and 19% better than 5/200.
• No eyes required enucleation or incisional surgery.

Conclusions:

• Evolving treatment trends for advanced Coats disease enhance patient outcomes and quality of life.
• Combined therapy with IVT bevacizumab, laser ablation, and triamcinolone acetonide yields improved anatomic results.
• This staged approach offers a safe and effective strategy for managing advanced Coats disease.