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Liu JH, Deng G, Ma J, Li L, Fang Y, Li S, Lu H. Clinical Characteristics of Pediatric Coats' Disease With Retinal Cyst Using Wide-Angle Fluorescein Angiography. Front Med (Lausanne) 2021; 8:709522. [PMID: 34778282 PMCID: PMC8578680 DOI: 10.3389/fmed.2021.709522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To assess the demographic and treatment features of pediatric patients of Coats' disease with retinal cyst using wide-angle FA. Design: A retrospective, hospital based, cross-sectional study. Participants: Pediatric patients of Coats' disease underwent wide-angle FA. Methods: A retrospective review of pediatric patients of Coats' disease who underwent wide-angle FA at a single center from January 2015 to July 2020. Demographic and treatment features were compared between patients with or without retinal cyst. Main Outcome Measures: Demographic and treatment outcomes. Results: There were 123 pediatric Coats' patients in our study, and 18.70% (23/123) of the patients developed complications with retinal cyst, 73.9% (17/23) of the retinal cysts were located in the inferior-temporal quadrant and 82.6% (19/23) of the retinal cysts were located in the peripheral retina anterior to the vortex veins. Compared with patients without retinal cyst, patients with retinal cyst had more clock-hours of telangiectasia on FA (7.32 vs. 5.41, p = 0.031), and may need more total treatments (7.47 vs. 3.53, p = 0.023) including laser photocoagulation (4.08 vs. 2.31, p = 0.019) or intravitreal anti-VEGF (3.13 vs. 2.23, p = 0.039), and also required a longer time for telangiectasia resolution (22.33 vs. 18.53 months, p = 0.043). Conclusion: Pediatric patients with Coats' disease complicated by retinal cyst presented with more clock-hours of telangiectasia on FA and needed more total treatments and longer time for telangiectasia resolution.
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Affiliation(s)
- Jing-Hua Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guangda Deng
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Ma
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Li
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuxin Fang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Songfeng Li
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hai Lu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Clinical features and prognostic factors in 71 eyes over 20 years from patients with Coats' disease in Korea. Sci Rep 2021; 11:6124. [PMID: 33731773 PMCID: PMC7969742 DOI: 10.1038/s41598-021-85739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022] Open
Abstract
This retrospective study assesses the clinical features, treatment strategies, and long-term outcomes of patients with Coats’ disease in Korea. Multimodal imaging and medical records of consecutive patients treated between July 2000 and April 2020 at two tertiary centers were evaluated based on onset age (adult vs. childhood [< 18 years]). Factors associated with final visual acuity (VA) and risk of treatment failure were assessed. A total of 71 eyes of 67 patients were included, with subgrouping by onset age showing 45% childhood and 55% adult cases. Overall, Stage 2 disease was most common at presentation (76%), though childhood cases had more Stage 3b (22% vs. 3%, P = 0.02) and greater clock hours of retinal telangiectasia (7 vs. 5, P = 0.005). First-line treatment included laser (25%), combined laser/anti-VEGF (23%), cryotherapy (20%), surgery (16%), and anti-VEGF only (9%). Cryotherapy was associated with a higher risk for secondary interventions (OR 11.8, P < 0.001), required in 56% overall. Despite a 3-line VA decrease in 34% overall, adult cases had superior final VA (P = 0.037). Multivariable regression showed that the number of anti-VEGF injections performed during the initial treatment period was associated with a 9.4 letter improvement in vision (P = 0.041). We observed a higher proportion of adult-onset Coats’ disease than previously reported in other non-Asian populations. An aggressive treatment with the addition of anti-VEGF may yield the most favorable long-term visual outcomes.
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SUBCLINICAL MACULAR CHANGES AND DISEASE LATERALITY IN PEDIATRIC COATS DISEASE DETERMINED BY QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2020; 39:2392-2398. [PMID: 30234852 PMCID: PMC6889904 DOI: 10.1097/iae.0000000000002322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optical coherence tomography angiography quantitative data in pediatric eyes with unilateral Coats disease found significant differences in vascular density and foveal avascular zone area between disease and fellow eyes that precede clinical signs. Purpose: To determine vascular change at the macula in both eyes in unilateral pediatric Coats disease using optical coherence tomography angiography. Methods: Retrospective case-series. Thirteen eyes of pediatric patients with a diagnosis of unilateral Coats disease of various stages were compared with 13 fellow eyes. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti. Scans were analyzed with novel projection artifact removal software and improved segmentation. Vascular density and foveal avascular zone area were calculated. Results: Vascular density was significantly decreased in eyes with Coats disease in comparison with fellow eyes in both the superficial capillary plexus and deep capillary plexus (43.7 ± 4.7 vs. 45.9 ± 4.4 [P = 0.000] and 43.0 ± 6.3 vs. 50.3 ± 2.2 [P = 0.001], respectively). The difference was also significant for most sectors of the macula. Foveal avascular zone area was significantly larger in eyes with Coats disease in comparison with fellow eyes (0.29 ± 0.1 vs. 0.24 ± 0.09 [P = 0.003]). These significant differences appeared as early as Stage 2A, preceding clinical findings. Conclusion: The findings support the unilaterality of Coats disease and show that vascular changes on optical coherence tomography angiography precede clinical staging of the condition.
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Chiu HH, Wan MJ, Kertes PJ, Muni RH, Lam WC. Visual outcomes after treatment in pediatric patients with Coats' disease. Can J Ophthalmol 2019; 54:647-652. [PMID: 31836093 DOI: 10.1016/j.jcjo.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report visual outcomes for children with Coats' disease after treatment. DESIGN Retrospective case series. PARTICIPANTS Pediatric patients with Coats' disease treated between 2000 and 2018 at a tertiary care pediatric hospital. METHODS Review of medical records. The primary outcome was visual acuity at final follow-up. Anatomical outcomes, retreatment, and risk factors for a poor outcome were also assessed. RESULTS There were 30 patients with Coats' disease. All cases were unilateral, and 28 (93%) were male. At presentation, 14 (47%) had stage 2 disease (retinal exudates) and 16 (53%) had stage 3 disease (subtotal or total exudative retinal detachment). All patients underwent laser photocoagulation and (or) cryopexy as primary treatment, combined with antivascular endothelial growth factor injection in 7 patients, posterior sclerotomy in 5 patients, and pars plana vitrectomy in 1 patient. Retreatment was required in 16 (53%) patients. After a median follow-up of 3.8 years, visual acuity was 20/50 or better in 6 patients (20%), 20/60 to 20/150 in 3 (10%), 20/200 to counting fingers in 8 (23%), and hand motion or worse in 14 (47%). Greater severity of disease at presentation was significantly associated with a poor visual outcome (p = 0.0001). In terms of complications, 7 (23%) eyes developed cataracts and 2 (7%) progressed to phthisis bulbi, but no patients required enucleation. CONCLUSIONS The visual prognosis for children with Coats' disease remains poor, particularly in patients with more severe disease at presentation. The risk of severe complications and enucleation is low after treatment.
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Affiliation(s)
- Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont.; The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont.; Department of Ophthalmology, St. Michael's Hospital, Toronto, Ont
| | - Wai-Ching Lam
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont.; Department of Ophthalmology, The University of Hong Kong, Hong Kong..
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Fluorescein angiography findings in diffuse retinoblastoma: two case reports with clinicopathologic correlation. J AAPOS 2017; 21:337-339.e2. [PMID: 28694215 DOI: 10.1016/j.jaapos.2017.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 02/13/2017] [Accepted: 03/05/2017] [Indexed: 11/22/2022]
Abstract
Whereas most retinoblastomas are seen as intraocular tumors, the diffuse infiltrating type is distinguished by a horizontal growth along the retina with minimal vertical growth. These findings can resemble other entities and present as a diagnostic challenge. Fluorescein angiography (FA) features of retinoblastoma have been described in the literature; however, to our knowledge, little information is available on the diffuse type. We present FA findings and the clinicopathlogic correlation of 2 patients with diffuse retinoblastoma. Changes observed on FA correlate with the vascular changes observed on histopathology and can therefore be helpful in the diagnosis of atypical retinoblastomas when the clinical presentation is equivocal.
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Soliman SE, Wan MJ, Heon E, Hazrati LN, Gallie B. Retinoblastoma versus advanced Coats' disease: Is enucleation the answer? Ophthalmic Genet 2016; 38:291-293. [PMID: 27435805 DOI: 10.1080/13816810.2016.1199715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sameh E Soliman
- a Department of Ophthalmology and Vision Sciences , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada.,b Department of Ophthalmology, Faculty of Medicine , University of Alexandria , Alexandria , Egypt
| | - Michael J Wan
- a Department of Ophthalmology and Vision Sciences , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Elise Heon
- a Department of Ophthalmology and Vision Sciences , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Lili-Naz Hazrati
- c Department of Pathology , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Brenda Gallie
- a Department of Ophthalmology and Vision Sciences , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
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Lee HJ, Jo DH, Kim JH, Yu YS. Clinical Characteristics of Retinoblastoma Patients whose Diagnosis was Difficult due to Atypical Ocular Manifestation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.5.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Haeng Jin Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Jo
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Fight against Angiogenesis-Related Blindness Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Fight against Angiogenesis-Related Blindness Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Fight against Angiogenesis-Related Blindness Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
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Suzani M, Moore AT. Intraoperative fluorescein angiography-guided treatment in children with early Coats' disease. Ophthalmology 2015; 122:1195-202. [PMID: 25824326 DOI: 10.1016/j.ophtha.2015.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To review the anatomic and visual outcomes of a series of children diagnosed with Coats' disease and treated on the basis of intraoperative fluorescein angiography (FA) findings. DESIGN Retrospective case series. PARTICIPANTS Twenty-five children 2 to 15 years of age diagnosed with early Coats' disease and treated after intraoperative FA. METHODS Retrospective review of patients who underwent treatment for stage 2 Coats' disease in a tertiary center in the United Kingdom between 2007 and 2012. The children underwent treatment to the telangiectatic vessels and associated areas of retinal nonperfusion identified on intraoperative FA performed with a wide-angle retinal camera (RetCam II). MAIN OUTCOME MEASURES Anatomic and structural assessment of the retina after treatment, visual acuity (VA), and complications related to treatment. RESULTS Twenty children with Coats' disease who underwent intraoperative RetCam FA and retinal ablative treatment and who had more than 3 months of follow-up were identified from clinical records. All had unilateral disease. Six eyes were classified as stage 2a, and 14 eyes were classified as stage 2b. The median duration of follow-up was 21 months (mean, 26 months). Fifteen eyes needed 1 treatment to stabilize the disease, and 5 eyes needed a second treatment. None of the patients demonstrated progression of the disease to a more severe stage. Twelve eyes had a final VA of 0.4 logarithm of the minimum angle of resolution (logMAR) or better, 6 patients had VA between 0.4 and 1.0 logMAR, and 2 patients had VA worse than 1.0 logMAR. CONCLUSIONS The treatment of retinal telangiectasia and areas of retinal nonperfusion identified by wide-angle intraoperative FA in children with stage 2 Coats' disease led to good anatomic outcome, with preservation of VA in most cases.
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Affiliation(s)
- Martina Suzani
- Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
| | - Anthony T Moore
- Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; Department of Ophthalmology, University of California, San Francisco, California.
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Liu DX, Gilbert MH, Wang X, Didier PJ, Shields CL, Lackner AA. Coats-like retinopathy in a Young Indian Rhesus Macaque (Macaca mulatta). J Med Primatol 2015; 44:108-12. [PMID: 25656754 DOI: 10.1111/jmp.12166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
A 1-year-old male Indian rhesus macaque presented with a bilateral blindness. Ocular examination, gross and histopathological evaluation, and immunohistochemistry were performed. The major findings were retinal telangiectasia, accumulation of exudate in the intraretinal and subretinal space, and retinal detachment. Coat-like retinopathy was diagnosed, and it has not been previously reported in veterinary medicine.
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Affiliation(s)
- David X Liu
- The Divisions of Comparative Pathology, Tulane University, Covington, LA, USA
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10
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Suesskind D, Altpeter E, Schrader M, Bartz-Schmidt KU, Aisenbrey S. Pars plana vitrectomy for treatment of advanced Coats' disease--presentation of a modified surgical technique and long-term follow-up. Graefes Arch Clin Exp Ophthalmol 2013; 252:873-9. [PMID: 24218042 DOI: 10.1007/s00417-013-2512-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/17/2013] [Accepted: 10/22/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To present a modified surgical technique in the treatment of retinal detachment secondary to advanced Coats' disease in children, and report on long-term anatomical and functional outcome. METHODS We analysed an interventional case series of 13 patients (13 eyes) with advanced Coats' disease characterised by retinal detachment in addition to massive subretinal exudates and vascular malformation. The presented patients underwent pars plana vitrectomy (PPV), including a modified technique of exocryotherapy applied after fluid-air exchange in order to achieve complete treatment of the vascular changes, to reduce associated side-effects, and to avoid retinectomy and silicone oil tamponade. RESULTS Within a median follow-up period of 37 months (range: 18-66 months), no enucleation was necessary. Four eyes (31 %) did not need any further therapy, and in nine eyes (69 %) additional treatments were performed. Six patients (46 %) required revisional surgery with silicone oil tamponade. In ten eyes (77 %), the pathologic vessels and exudates finally regressed and the retina reattached. Visual acuity (VA) could be stabilized in the majority of patients: in three eyes (27 %) VA improved, in four eyes (36 %) VA remained stable, in four eyes (36 %) visual acuity (VA) deteriorated, and in two eyes VA could not be evaluated. CONCLUSIONS The presented modified technique allows for sufficient cryotherapy of vascular malformations, even in the presence of massive exudation, in a subset of patients with advanced Coats' disease, and thus may reduce surgery-related complications and improve the rehabilitation process of these young patients.
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Affiliation(s)
- Daniela Suesskind
- Center for Ophthalmology, Eberhard-Karls-University of Tuebingen, Schleichstr. 12-16, 72076, Tuebingen, Germany,
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Henry CR, Berrocal AM, Hess DJ, Murray TG. Intraoperative Spectral-Domain Optical Coherence Tomography in Coats’ Disease. Ophthalmic Surg Lasers Imaging Retina 2012; 43 Online:e80-4. [PMID: 22827477 DOI: 10.3928/15428877-20120719-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 06/07/2012] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher R Henry
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Florida, USA
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Shields CL, Schoenberg E, Kocher K, Shukla SY, Kaliki S, Shields JA. Lesions simulating retinoblastoma (pseudoretinoblastoma) in 604 cases: results based on age at presentation. Ophthalmology 2012; 120:311-6. [PMID: 23107579 DOI: 10.1016/j.ophtha.2012.07.067] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/21/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To determine the types and frequency of ocular conditions that simulate retinoblastoma (pseudoretinoblastoma) based on age at presentation. DESIGN Retrospective case series. PARTICIPANTS Two thousand seven hundred seventy-five patients. METHODS Chart review. MAIN OUTCOME MEASURES Conditions simulating retinoblastoma. RESULTS Of 2775 patients referred for management of retinoblastoma, 2171 patients (78%) had confirmed retinoblastoma and 604 patients (22%) had simulating lesions (pseudoretinoblastomas). In the pseudoretinoblastoma cohort, the mean patient age at presentation was 4 years (median, 2 years). There were 27 different pseudoretinoblastoma conditions, and the 10 most common included Coats' disease (n = 244; 40%), persistent fetal vasculature (PFV; n = 158; 28%), vitreous hemorrhage (n = 27; 5%), ocular toxocariasis (n = 22; 4%), familial exudative vitreoretinopathy (FEVR; n = 18; 3%), rhegmatogenous retinal detachment (n = 18; 3%), coloboma (n = 17; 3%), astrocytic hamartoma (n = 15; 2%), combined hamartoma of retina and retinal pigment epithelium (n = 15; 2%), and endogenous endophthalmitis (n = 10; 2%). Simulating lesions differed based on age at presentation, and children younger than 1 year were most likely to have PFV (49%), Coats' disease (20%), or vitreous hemorrhage (7%); those 2 to 5 years of age were most likely to have Coats' disease (61%), toxocariasis (8%), or PFV (7%); and those older than 5 years were most likely to have Coats' disease (57%), toxocariasis (8%), or FEVR (6%). CONCLUSIONS The most common pseudoretinoblastomas include Coats' disease, PFV, and vitreous hemorrhage, but the spectrum varies depending on patient age.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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14
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Silva RA, Dubovy SR, Fernandes CE, Hess DJ, Murray TG. Retinoblastoma with Coats' response. Ophthalmic Surg Lasers Imaging Retina 2011; 42 Online:e139-43. [PMID: 22165951 DOI: 10.3928/15428877-20111208-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 10/28/2011] [Indexed: 11/20/2022]
Abstract
Although it is well known that a variety of pediatric ocular diseases may clinically resemble retinoblastoma, perhaps of more concern is when the actual tumor mimics seemingly benign ocular lesions. The authors present two cases of retinoblastoma with a Coats' response as evidence of the challenge often encountered in evaluating intraocular malignancies. The cases further emphasize the need for retaining a high level of clinical suspicion for more malicious diseases, often using repeated fundus evaluations when a diagnosis remains ambiguous.
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Affiliation(s)
- Ruwan A Silva
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, Florida, USA
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Silva CT, Brockley CR, Crum A, Mandelstam SA. Pediatric Ocular Sonography. Semin Ultrasound CT MR 2011; 32:14-27. [DOI: 10.1053/j.sult.2010.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Coats disease is characterized by idiopathic congenital retinal telangiectasis and exudative retinopathy. Mostly young males are affected. The disease is usually unilateral. Visual prognosis varies from full visual acuity to blindness according to the extent of retinal exudation. Retinoblastoma is a major differential diagnosis particularly in small children but other causes of exudative retinopathy must also be considered. Treatment aims include obliteration of the telangiectasis in order to resolve retinal exudation and achieve reattachment of the retina. Therapeutic options comprise laser coagulation or cryotherapy, drainage of subretinal fluid, buckling surgery and pars plana vitrectomy. In more advanced cases with therapy-resistant secondary glaucoma enucleation may be required. More recently, intravitreal administration of VEGF inhibitors has become an option.
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Affiliation(s)
- B Junker
- Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106 Freiburg.
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Mulvihill A, Morris B. A population-based study of Coats disease in the United Kingdom II: investigation, treatment, and outcomes. Eye (Lond) 2010; 24:1802-7. [PMID: 20865028 DOI: 10.1038/eye.2010.127] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS coats disease is an uncommon form of retinal telangiectasia. We conducted a prospective population-based study of Coats disease in the United Kingdom to provide a more balanced picture. This paper reports the investigations and treatments used for Coats disease and their anatomic and visual outcomes. METHODS the study was conducted through the British Ophthalmic Surveillance Unit. All ophthalmologists notifying cases of Coats disease were sent a baseline questionnaire and a follow-up questionnaire after 6 months. RESULTS in total, 55 baseline and 42 follow-up questionnaires were returned. All cases were unilateral. Ultrasound was performed in 26% of cases, fluorescein angiography in 35%, and examination under anaesthesia in 42% of the cases. Laser photocoagulation was by far the primary treatment modality, used in 92%, with cryotherapy used mainly as a second-line or adjunctive treatment. In more advanced cases with significant retinal detachment, laser photocoagulation combined with pars plana vitrectomy and drainage of sub-retinal fluid can produce anatomic stability and prevent progress to end-stage disease. Intravitreal injections of steroids or VEGF inhibitors are currently of unproven efficacy in Coats disease. Overall, treatment resulted in stabilisation of visual acuity. Anatomic stabilisation or improvement was achieved in virtually all eyes. CONCLUSION laser photocoagulation to telangiectatic retinal vessels is the most commonly used treatment for Coats disease. Other treatments are either adjunctive or of unproven efficacy. A realistic treatment goal is to achieve anatomic stability and avoidance of enucleation for painful end-stage disease. Visual improvement is however unlikely.
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Affiliation(s)
- A Mulvihill
- Princess Alexandra Eye Pavilion, Edinburgh, UK.
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Grabowska A, Calvo JP, Fernandez-Zubillaga A, Rios JCS, Gómez JA. A magnetic resonance imaging diagnostic dilemma: diffuse infiltrating retinoblastoma versus Coats' disease. J Pediatr Ophthalmol Strabismus 2010; 47 Online:e1-3. [PMID: 21158370 DOI: 10.3928/01913913-20100818-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 05/12/2010] [Indexed: 11/20/2022]
Abstract
A 6-year-old boy presented with neovascular glaucoma secondary to total retinal detachment. Magnetic resonance imaging findings suggested diffuse infiltrating retinoblastoma. Enucleation was subsequently performed and led to a final histopathological diagnosis of advanced Coats' disease. Diffuse infiltrating retinoblastoma and advanced Coats' disease can be indistinguishable from each other on magnetic resonance imaging.
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Affiliation(s)
- Anna Grabowska
- Department of Ophthalmology, University Hospital La Paz, Madrid, Spain.
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Huang S, Crawford JB, Porco T, Rutar T. Clinicopathologic review of pediatric enucleations during the last 50 years. J AAPOS 2010; 14:328-33. [PMID: 20736124 DOI: 10.1016/j.jaapos.2010.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 05/13/2010] [Accepted: 05/18/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate diagnoses leading to enucleations in the pediatric age group over time. METHODS All pathology reports of enucleation specimens at the University of California-San Francisco eye pathology laboratory from children (ages 0 to 18 years) from 1960 to 2008 were reviewed. The main outcome measures were the frequency of pediatric enucleation specimens in each diagnostic category as compared with total pathological laboratory volume over time, and the age and gender distribution of histopathological diagnostic categories over time. RESULTS Specimens of 746 eyes from 729 pediatric patients were analyzed. Pediatric enucleated eyes constituted 2.7% of all specimens received at the pathology laboratory. The overall frequency of pediatric enucleation specimens did not change over time. Retinoblastoma specimens increased by a factor of 2.9 over time (p < 0.0001). The increase in retinoblastoma was offset by a decrease in nonretinoblastoma enucleations, which decreased by a factor of 3.8 between the 1960s and 2000s (p < 0.0001), driven by a decrease in enucleations caused by trauma (p < 0.0001). Beginning in the 1980s, pediatric enucleations caused by nonrhegmatogenous retinal detachment, nematode and non-nematode endophthalmitis, and congenital glaucoma decreased significantly. Retinoblastoma was the most common diagnosis overall (45%), in girls (60%), and in ages <5 years (78%). Trauma was the second most common diagnosis (32%) and the most common in boys (42%) and in children ages 6-12 (58%) and 13-18 (72%) years. CONCLUSIONS A decrease in pediatric nonretinoblastoma enucleations was observed over time, possibly attributable to better diagnostic capabilities, surgical techniques, and public health interventions. The increase in retinoblastoma enucleations over time was likely due to the result of institutional referral bias.
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Affiliation(s)
- Susan Huang
- Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California-San Francisco, 10 Koret Way, San Francisco, CA 94143, USA
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Dhoot DS, Weissman JL, Landon RE, Evans M, Stout JT. Optic nerve enhancement in Coats disease with secondary glaucoma. J AAPOS 2009; 13:301-2. [PMID: 19541272 DOI: 10.1016/j.jaapos.2009.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 11/29/2022]
Abstract
Differentiating between Coats disease and retinoblastoma can be challenging. Magnetic resonance imaging typically is obtained when retinoblastoma is suspected to evaluate for a mass or optic nerve infiltration, the latter appearing as an enhancing lesion. We report a case of optic nerve enhancement observed in the setting of an acute secondary glaucoma in a patient with unilateral Coats retinopathy. Given the gravity of the decision to recommend enucleation on the basis of clinical findings consistent with retinoblastoma, physicians must be aware of the possibility of optic nerve enhancement in the setting of inflammation and raised intraocular pressure.
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Affiliation(s)
- Dilsher S Dhoot
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239-4197, USA
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Förl B, Schmack I, Grossniklaus HE, Rohrschneider K. [Coats' disease. Important differential diagnosis for retinoblastoma]. Ophthalmologe 2008; 105:761-4. [PMID: 18299842 DOI: 10.1007/s00347-007-1645-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Advanced Coats' disease is one of the most difficult differential diagnoses of retinoblastoma in early childhood. We describe the clinical and histological findings in two boys, ages 9 months and 21 months, with unilateral leucocoria. Despite comprehensive diagnostics that included examination under general anaesthesia, magnetic resonance imaging, and ultrasound, retinoblastoma could not be excluded, and the eyes were enucleated. Histological diagnosis of Coats' disease was confirmed. Because differentiation between retinoblastoma and Coats' disease may be difficult, enucleation seems to be indicated in uncertain cases due to the reduced visual prognosis and the risk of secondary complications in advanced Coats' disease.
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Affiliation(s)
- B Förl
- Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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Lam HD, Samuel MA, Rao NA, Murphree AL. Retinoblastoma presenting as Coats’ disease. Eye (Lond) 2008; 22:1196-7. [DOI: 10.1038/sj.eye.6703046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Affiliation(s)
- Jerry A Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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