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Rishi P, Rishi E, Attiku Y, Uparkar M, Bhende P, Bhende M, Sen P. Surgical Management of Advanced Coats Disease in 32 Eyes: A 20-Year Study. JOURNAL OF VITREORETINAL DISEASES 2020; 4:467-471. [PMID: 37007657 PMCID: PMC9976077 DOI: 10.1177/2474126420930504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work studies outcomes of external subretinal fluid (SRF) drainage in management of eyes with advanced Coats disease. Methods: Patients with advanced-stage Coats disease (≥stage 3B), who were younger than 12 years and underwent external SRF drainage from 1996 to 2016, were included in this retrospective study. Surgical intervention involved external drainage of SRF and cryotherapy. SRF drainage was performed by lamellar scleral dissection or by external needle drainage. Favorable anatomical outcome was defined as retinal reattachment with normal intraocular pressure (IOP). IOP greater than 24 mm Hg was considered raised. Univariate and multivariate analyses were performed to measure the association between preoperative or intraoperative factors and retinal status at final follow-up. Outcome measures evaluated included visual acuity, IOP, retinal status, globe status, and complications of surgery. Kaplan-Meier analysis was performed for globe salvage without pain. Results: Thirty-two eyes of 32 patients were included in the study. Mean age at surgery was 3.8 ± 3 years. The mean duration of follow-up was 7 years (range, 6 months-15.7 years). Improvement in visual acuity was seen in 5 eyes. Retina was attached at final visit in 6 eyes. IOP in the range of 8 to 24 mm Hg was noted in 16 eyes. Favorable anatomical outcome was achieved in 3 (9%) eyes. Globe salvage was achieved in 84% of eyes. Complications included intraoperative vitreous hemorrhage (n = 1) and postoperative inflammation (n = 1). Kaplan-Meier ocular survival rate without pain at 10 years was 76%. Conclusions: SRF drainage and cryotherapy in eyes with advanced Coats disease favorably alter the natural history of the disease and prevent end-stage complications. Visual outcomes remain poor.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Yamini Attiku
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Mahesh Uparkar
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Pramod Bhende
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Parveen Sen
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamilnadu, India
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Yang X, Wang C, Su G. Recent advances in the diagnosis and treatment of Coats' disease. Int Ophthalmol 2019; 39:957-970. [PMID: 30895419 DOI: 10.1007/s10792-019-01095-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To review and summarize the recent progress in the diagnosis and treatment of Coats' disease. METHODS Literature was collected from Web of Science, Medline and Pubmed, through searching of these keywords: "Coats' disease", "diagnosis" and "treatment". RESULTS Coats' disease is characterized by idiopathic leaky retinal vascular telangiectasia and microvascular abnormalities often accompanied by intraretinal or subretinal exudation and retinal detachment. Neovascular glaucoma and phthisis bulbi often occur in advanced cases. Coats' disease has significant diversity in terms of its clinical presentation and morphology. Anti-VEGF therapy combined with laser photocoagulation for early Coats' disease and anti-VEGF therapy combined with minimally invasive vitrectomy for advanced Coats' disease can achieve good efficacy. CONCLUSION Early diagnosis and timely treatment based on clinical stage are critical to retaining the patient's visual function. Patients should be aware that close long-term follow-up is necessary.
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Affiliation(s)
- Xinyue Yang
- Department of Ophthalmology, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Chenguang Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Guanfang Su
- Department of Ophthalmology, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China.
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LONG-TERM ANATOMICAL AND FUNCTIONAL OUTCOMES FOLLOWING VITRECTOMY FOR ADVANCED COATS DISEASE. Retina 2018; 37:1757-1764. [PMID: 27984550 DOI: 10.1097/iae.0000000000001415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the long-term anatomical and functional results of vitreoretinal surgery in patients with advanced Coats disease. METHODS Retrospective analysis of 23 patients who underwent 23-gauge pars plana vitrectomy combined with transscleral cryotherapy, laser photocoagulation, and intraocular tamponade between 2005 and 2014 and had a follow-up of at least 1 year. The primary outcomes were mean visual acuity and anatomical success. RESULTS The average age at the time of surgery was 8.7 ± 1.3 years (range, 2-18 years). The mean follow-up period was 55.2 ± 31 months (range, 12-120 months). In 16 eyes (70%), further treatment was not necessary. In the remaining 7 patients (30%), revision surgery with silicone oil tamponade was required. In 20 eyes (87%), the retina was reattached. At the final visit, 8 eyes (35%) had improved mean Snellen visual acuity from 20/1,000 at initial presentation to 20/160, 3 eyes (13%) showed stabilization, and 6 eyes (26%) had decline in visual acuity. No enucleation was necessary, and no progression to neovascular glaucoma was observed. CONCLUSION Pars plana vitrectomy combined with cryotherapy, laser photocoagulation, and intraocular tamponade could be an effective treatment option for advanced Coats disease. Despite surgery, disease-related complications remained high, but the main aim of management in these young patients is functional and anatomical stability.
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Ong SS, Buckley EG, McCuen BW, Jaffe GJ, Postel EA, Mahmoud TH, Stinnett SS, Toth CA, Vajzovic L, Mruthyunjaya P. Comparison of Visual Outcomes in Coats' Disease: A 20-Year Experience. Ophthalmology 2017; 124:1368-1376. [PMID: 28461016 DOI: 10.1016/j.ophtha.2017.03.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report differences in visual acuities among patients with Coats' disease who sought treatment at a tertiary care university-based practice. DESIGN Single-center retrospective cohort study. PARTICIPANTS Patients with Coats' disease diagnosed clinically, angiographically, or both from 1995 through 2015. METHODS Patients were divided into 2 groups based on date of presentation: decade 1 (1995-2005) and decade 2 (2006-2015). MAIN OUTCOME MEASURES Visual acuity (VA). RESULTS Thirty-nine eyes of 39 patients were included with 19 eyes presenting in decade 1 and 20 eyes presenting in decade 2. Three patients demonstrated bilateral disease, but only the worse eye was included for analysis. Forty-seven percent of eyes in decade 1 demonstrated advanced stages of disease (stage 3B or worse) compared with 20% of eyes in decade 2. There was a trend for the mean initial presenting VA (±standard deviation) for decade 1 eyes to be worse (2.05±1.29 logarithm of the minimum angle of resolution [logMAR]) than for decade 2 eyes (1.45±0.99 logMAR; P = 0.1). From initial to final follow-up visit, mean VA also worsened for decade 1 eyes (P = 0.03), but remained stable for decade 2 eyes (P = 1.0). At the end of follow-up, there was a trend for mean VA for decade 1 eyes (2.28±1.17 logMAR) to be worse than for decade 2 eyes (1.60±1.15 logMAR; P = 0.07). Eight eyes were observed initially in decade 1 compared with 1 eye in decade 2, and only 1 of the observed eyes (in decade 2) developed painful glaucoma requiring enucleation. Decade 2 eyes had a higher average number of procedures per eye (6.5±4.9) compared with decade 1 eyes (1.4±1.7; P < 0.001). CONCLUSIONS The earlier presentation of disease in decade 2 suggests improvements in disease detection over time. Furthermore, there was a trend for eyes to have better final VA in this decade. This is due to a combination of factors, including earlier presentation of disease, fewer eyes being observed without treatment, and eyes, when treated, receiving a higher number of procedures.
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Affiliation(s)
- Sally S Ong
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Edward G Buckley
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Brooks W McCuen
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Eric A Postel
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Tamer H Mahmoud
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; Department of Ophthalmology, Stanford University Medical Center, Palo Alto, California.
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Capuano V, Miere A, Amoroso F, Todisco L, Cohen SY, Souied E, Querques G. Uncommon retinal vascular diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1251315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE To review current literature on Coats disease and provide a structured framework for differentiating challenging clinical features in Coats disease patients. METHODS We critically reappraise historical and current literature and present clinical methods for developing a thorough differential diagnosis and management strategy for Coats disease. RESULTS Coats disease is a sporadic, usually unilateral condition typically occurring in young males. When untreated, this disorder can lead to total exudative retinal detachment and secondary glaucoma. CONCLUSIONS Anti-VEGF agents are currently a treatment option in combination with ablative therapy of telangiectatic vessels. Anti-VEGF agents appear particularly useful for patients with extensive areas of exudative retinal detachment, and are an effective treatment option for total retinal detachment.
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Bilateral Coats' Disease Combined with Retinopathy of Prematurity. Case Rep Ophthalmol Med 2015; 2015:364395. [PMID: 26413362 PMCID: PMC4568049 DOI: 10.1155/2015/364395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/16/2015] [Accepted: 08/19/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To report a case of bilateral Coats' disease combined with retinopathy of prematurity (ROP). Case. Retinal vascularization was complete in the right eye, whereas zone III, stage 3 ROP and preplus disease were observed in the left eye at 43 weeks of postmenstrual age (PMA) in a 31-week premature, 1200-g neonate. Intraretinal exudates developed and retinal hemorrhages increased in the left eye at 51 weeks of PMA. Diode laser photocoagulation (LP) was applied to the left eye. Exudates involved the macula, and telangiectatic changes developed one month following LP. Additional LP was applied to the left eye combined with intravitreal bevacizumab (IVB) injection at 55 weeks of PMA. Disease regressed one month after the additional therapy. At the 14-month examination of the baby, telangiectatic changes and intraretinal exudates were observed in the right eye. Diode LP was applied to the right eye combined with IVB injection. Exudates did not resolve completely, and cryotherapy was applied one month following LP. Retinal findings regressed three months following the cryotherapy. Conclusion. This is the first report of presumed bilateral Coats' disease combined with ROP. If Coats' disease could be diagnosed at early stages, it would be a disease associated with better prognosis.
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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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Cai X, Zhao P, Zhang Q, Jin H. Treatment of stage 3 Coats' disease by endolaser photocoagulation via a two-port pars plana nonvitrectomy approach. Graefes Arch Clin Exp Ophthalmol 2015; 253:999-1004. [PMID: 25794987 PMCID: PMC4483254 DOI: 10.1007/s00417-015-2984-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the effectiveness of endolaser photocoagulation by a two-port pars plana nonvitrectomy approach for treating Coats’ disease with shallow exudative retinal detachment. Methods This study included 24 patients (23 boys with an age range of 2–17 years, and one girl, age 6 years) with stage 3 Coats’ disease (25 eyes) from December 2012 and May 2014 at a single center. All of the 25 eyes were complicated with serous or total retinal detachment and received none-vitrectomized endolaser: two (23- or 25-gauge) incisions were routinely made 3 mm posterior to the corneal limbus and a laser was applied directly on the abnormal blood vessels. Additional treatments included subretinal fluid drainage (five eyes), intravitreal triamcinolone injection (seven eyes), and intravitreal anti-vascular endothelial growth factor (VEGF) injection (17 eyes). Best-corrected visual acuity, intraocular pressure, and fundus and abnormal vascular changes were recorded to determine therapeutic effects. Results Twenty-four out of the 25 treated eyes (96 %) had retina reattached. The number of treatment sessions differed case by case (1–5 sessions, average 1.96) and the time to full treatment of retinal reattachment was 4 months in average. One patient (4 %) presented with retinal redetachment. Five (20 %) eyes received further laser treatment with indirect ophthalmoscope and four eyes (16 %) presented with total retinal detachment at their first visits received consecutive treatments. At the end of the follow-up period (mean, 10.08 months), telangiectasias of 24 (96 %) eyes were resolved and no severe complications occurred. Conclusions Endolaser photocoagulation by a two-port pars plana nonvitrectomy approach is an effective treatment for advanced Coats’ disease with serous retinal detachment. The long-term safety of the approach needs further investigation.
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Affiliation(s)
- Xuan Cai
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China 200092
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China 200092
| | - Qi Zhang
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China 200092
| | - Haiying Jin
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China 200092
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