A Case of Coats' Disease with Spontaneous Retinal Reattachment after Total Detachment

Surgical Approaches to Serous Retinal Detachment With Retina-Lens Touch in Eyes With Nanophthalmos

Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina-lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.

Spontaneous Resolution of a Rhegmatogenous Retinal Detachment

A retinal detachment is the term used to describe detachment of the neurosensory retina from the underlying membrane, the retinal pigment epithelium (RPE). Rhegmatogenous detachments are caused by a break in the retina through which fluid passes from the vitreous cavity into the subretinal space. The incidence of rhegmatogenous retinal detachment in the general population in Europe is 1 in 10 000 persons per year. Danger is the greatest in the age range from 55 to 70 years. Without treatment, blindness in the affected eye may occur. Individual risks depend on the presence or absence of specific factors including myopia, positive family anamnesis, retina rupture, trauma, ablation in the other eye, ablation in a vitreous body, retina high-risk peripheral de-generations and vitreoretinal degenerations. Majority of the untreated rhegmatogenous retina ablations progress to the subtotal or total retinal detachment and blindness. This paper describes a very rare case of the spontaneous complete reattachment of the sensory retina to the retinal pigment epithelium in a patient with the total rhegmatogenous retinal ablation in the right eye. The female patient, who was 52 years old, was examined by an Ophthalmologist after she had experienced a sudden loss of vision, 2 months before appointment. After a detailed ophthalmological examination, a total rhegmatogenous retinal ablation of the right eye was diagnosed. The best corrected visual acuity, evaluated on a Snellen chart, was 2/60. The patient was referred to a tertiary-level Institution since a surgical intervention of the ablation was needed. Due to technical inabilities in the above-mentioned Institution, the operation was not performed, and despite the recommendation to perform the intervention in another tertiary level Institution, the patient did not have ophthalmological examinations during the following three months. During the next visit, the Ophthalmologist determined that there was a spontaneous retinal fixation on the retinal pigment epithelium and a partial restoration of the visual function of the affected eye which was evaluated at 0.5.

Coats' disease: trends and long-term treatment outcomes in a tertiary referral centre

Background:

The long-term treatment outcomes in Coat’s disease – particularly in the era of newer pharmacotherapies such as anti-vascular endothelial growth factor (VEGF) agents and depot steroids – are poorly understood.

Aim:

To describe the clinical features and treatment outcomes of 148 eyes with Coats’ disease assessed in a referral centre over 30 years.

Materials and methods:

We conducted a retrospective chart review of patients diagnosed with Coats’ disease between 1 June 1987 and 31 July 2017. The demographic, clinical and treatment data were collected and long-term functional and anatomical outcomes were analysed based on the treatment either with conventional therapy (cryo/laser) or along with adjuvants like intravitreal steroids or anti-VEGFs.

Results:

The mean age at presentation was 15.22 years (median 11). Familial exudative vitreoretinopathy was the most common referral diagnosis, 76/148 (51.5%), followed by Coats’ disease, 37/148 (25%), and retinoblastoma, 35/148 (23.6%). Stage 3B was most common at presentation (31.8%), followed by 2B (22.3%) and 2A (16.9%). A total of 107 patients were treated either with conventional therapy or in combination with adjuvants. The mean follow-up period was 24.95 months. The visual acuity improved from baseline logMAR 2.17 (Snellen-20/2958) to logMAR 1.88 (Snellen-20/1517) at final follow-up (p = 0.004). The improvement in visual acuity was better when the presenting BCVA was <1 logMAR (Snellen 20/200), p = 0.004. No statistically significant change in BCVA was noted between conventional and adjuvant groups, p = 0.5. However, the final anatomical outcome was good in 78/99 (78.8%) in the conventional group and 45/49 (91.8%) in the adjuvant group, respectively (p = 0.046).

Conclusion:

In this series of patients with Coats’ disease over three decades, the use of intravitreal steroids or anti-VEGFs as adjuvants resulted in better anatomical outcomes. A better baseline visual acuity, lower stage of the disease, and older age at presentation were found to be the factors leading to favourable visual outcomes.

Summary

In the current series of 148 eyes with Coats’ disease, adjuvant treatment with intravitreal steroids or anti-VEGFs resulted in better outcomes as compared with conventional cryotherapy or laser photocoagulation alone. Patients with Coats’ disease who had presented with better visual acuity at baseline, lower stage of the disease and older age had better final visual outcomes.

Neglected Coats Disease

Coats disease is a rare, non-hereditary retinal vascular abnormality that typically presents in the first two decades of life and is characterized by idiopathic retinal telangiectasia with progressive exudation. The authors describe a patient with Coats disease in which the family neglected treatment, demonstrating the natural course of this disease. [J Pediatr Ophthalmol Strabismus. 2020;57:e82-e85.].