Multimodal imaging features of adult-onset Coats disease: A case series

The imaging manifestations of adult-onset Coats disease differ from those in children. This study explored the multimodal imaging features of adult-onset Coats disease. This study included patients diagnosed with adult-onset Coats disease (>18 years) from December 2021 to December 2024 at Jinan Mingshui Eye Hospital. Data on best corrected visual acuity (BCVA), computerized optometry, intraocular pressure (IOP), slit lamp microscope, indirect ophthalmoscope, ocular B-ultrasound, ultra-wide field fundus imaging (UWFI), ultra-wide field fluorescein fundus angiography (UW-FFA), and optical coherence tomography (OCT) were collected. The study included fifteen patients (16 eyes). The mean subject age was 51 ± 11.8 years, with 12 males (13 eyes) and 3 females (3 eyes). Fourteen patients showed painless decline in monocular vision, and 1 patient had no symptoms. The affected eyes had a median logMAR BCVA of 1.10 (range 0.00-2.00). Ocular B-ultrasonography showed no massive vitreous opacities in all patients; 2 cases were reported with localized exudative retinal detachment, and 3 cases showed localized solid elevations adjacent to the ocular wall. UWFI examination showed yellow-white hard exudation in all patients, varying in scope and degree. Some arteriole branches showed a "lightbulb" appearance, and small bleeding was interspersed around them. There were 13 cases with exudation involving the macula. Fundus lesions were consistent with typical Coats disease exudation in 6 cases (40.0%), Leber miliary aneurysm (LMA) in 4 cases (26.7%), and macular telangiectasia type 1 (MacTel 1) in 5 cases (33.3%). UW-FFA examination showed convoluted and dilated small vessels in the fundus lesion, and the vascular wall showed cystic, fusiform, or bead-like neoplasia changes. No perfusion areas of varying degrees could be seen in the peripheral area in the early stage of all patients. In the late stage, abnormal angiofluorescein leakage and staining were observed. FFA showed that the lesions involved the macula in 14 cases, and fundus abnormalities in fellow eyes were found in 8 patients (53.3%). OCT examination showed different degrees of macular edema with hyperreflective mass in 14 cases and epiretinal membranes in 5 cases. Adult-onset Coats disease is rare in the clinic, and the range and types of fundus lesions are diverse. More than half of the patients have abnormalities in FFA in the fellow eye, and a detailed examination should be carried out in combination with multiple imaging modes, especially UW-FFA.