Progression of Coats Disease in Nigerian Female Treated with Repeat Intravitreal Bevacizumab: A Case Report

To report the nonresponse to intravitreal bevacizumab (IVB) and the progression from Leber's miliary aneurysm (LMA) to exudative Coats disease (CD) in a 14 year old Nigerian girl who received rescue treatment combining cryotherapy and intravitreal triamcinolone. Additionally, reporting LMA and CD in two other Nigerian females, detailing their treatment and outcomes. The first case involved a 14-year-old girl diagnosed with bilateral extrafoveal LMA, with best-corrected visual acuity (BCVA) of OD 6/9 and OS 6/6. She underwent a total of ten bilateral IVB treatments over 2 years due to the initial retinal laser photocoagulation's failure to control leakage. Despite IVB, her OD progressed to CD with severe intraretinal and subretinal exudation, exudative retinal detachment (RD), secondary cataracts, and a substantial reduction in vision. Her further management included lensectomy, subretinal fluid drainage, cryotherapy, and intravitreal triamcinolone. The RD resolved, and her vision stabilized at hand motion. The second case involved a 14-year-old girl diagnosed with unilateral CD, featuring widespread foveal involvement, retinal exudation, and inferior exudative RD in OD, with a BCVA of counting fingers. Treatment included subretinal fluid drainage, cryotherapy, and intravitreal triamcinolone. The RD resolved, and her vision improved to 6/60. The third case described a 32-year-old female with telangiectatic retinal vessels and foveal involvement due to intraretinal exudation, diagnosed with LMA in OS, which reduced her vision to 6/36. She defaulted on clinic appointments. The first case suggests that IVB alone may not be sufficient to control certain types of LMA and CD. Collectively, these three cases propose that in Nigerians and Africans, a female predisposition to LMA and CD may be more prevalent, contrasting with the male predisposition observed in other races.