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Daruich A, Bremond-Gignac D, Aziz A, Couret C, Gallice M, Krivosic V, Lequeux L, Matet A, Metge F, Mière A, Ramtohul P. [National protocol for diagnosis and treatment of Coats disease: Summary for attending and primary care physicians]. J Fr Ophtalmol 2025; 48:104539. [PMID: 40339459 DOI: 10.1016/j.jfo.2025.104539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Accepted: 03/27/2025] [Indexed: 05/10/2025]
Abstract
Coats disease (ORPHA:190) is a rare retinal disorder characterized by variable clinical presentation and severity, often leading to diagnostic delays and potentially causing both functional and anatomic consequences for the affected eye. Early detection and treatment are essential for a favorable prognosis and to prevent delays in addressing differential diagnoses, with retinoblastoma, the most common malignant ocular tumor in children, being the most critical concern. The objective of this National Diagnosis and Treatment Protocol (PNDS) is to present the optimal current diagnostic and therapeutic management strategies to the involved healthcare professionals, as well as the care pathway for patients requiring treatment for Coats disease. It aims to optimize and standardize the management of this rare condition across the entire country. The key diagnostic, treatment, and follow-up options will be reviewed to establish best practice recommendations.
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Affiliation(s)
- A Daruich
- OPHTARA, Filière Sensgene, Ophthalmology Department, Centre de Maladies Rares en Ophtalmologie (CRMR), Necker-Enfants Malades University Hospital, Paris-Cité University, AP-HP, Paris, France; Inserm, UMRS1138, Team 17, from Physiopathology of Ocular Diseases to Clinical Development, Centre de Recherche des Cordeliers, Sorbonne Paris-Cité University, Paris, France.
| | - D Bremond-Gignac
- OPHTARA, Filière Sensgene, Ophthalmology Department, Centre de Maladies Rares en Ophtalmologie (CRMR), Necker-Enfants Malades University Hospital, Paris-Cité University, AP-HP, Paris, France; Inserm, UMRS1138, Team 17, from Physiopathology of Ocular Diseases to Clinical Development, Centre de Recherche des Cordeliers, Sorbonne Paris-Cité University, Paris, France
| | - A Aziz
- Ophthalmology Department, Nord University Hospital, AP-HM, Marseille, France
| | - C Couret
- Ophthalmology Department, Nantes University Hospital, Nantes University, Nantes, France
| | - M Gallice
- Department of Ophthalmology, Grenoble-Alpes University Hospital, Grenoble, France
| | - V Krivosic
- Ophthalmology Department, Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Université Paris-Cité, AP-HP, Paris, France
| | - L Lequeux
- Rive Gauche Ophtalmology, Clinique Rive Gauche, Toulouse, France
| | - A Matet
- Department of Ocular Oncology, Institut Curie, Université Paris-Cité, Paris, France; Inserm, UMRS1138, Team 17, from Physiopathology of Ocular Diseases to Clinical Development, Centre de Recherche des Cordeliers, Sorbonne Paris-Cité University, Paris, France
| | - F Metge
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - A Mière
- Ophthalmology Department, Intercommunal Hospital of Créteil, Créteil, France
| | - P Ramtohul
- Ophthalmology Department, Nord University Hospital, AP-HM, Marseille, France
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2
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Medina RJ, Bansal R, Shields CL. Failure to Thrive With Unilateral Proptosis and Xanthocoria in a Young Boy. J Pediatr Ophthalmol Strabismus 2025; 62:228. [PMID: 39465577 DOI: 10.3928/01913913-20241001-03] [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: 10/29/2024]
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3
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Vinekar A, Wu WC, Lorenz B, Bavaskar S, Berrocal A, Lopez-Cañizares A, Fung N, Lam WC, M.llop S, Mangalesh S, Ozdek S, Toth C. Rare pediatric retinal diseases: A review. Indian J Ophthalmol 2025; 73:622-636. [PMID: 40272290 PMCID: PMC12121860 DOI: 10.4103/ijo.ijo_1542_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 10/20/2024] [Accepted: 02/17/2025] [Indexed: 04/25/2025] Open
Abstract
Rare pediatric retinal disorders present significant challenges in diagnosis and management due to their limited prevalence and diverse clinical manifestations. This paper provides a comprehensive review of select rare retinal disorders affecting the pediatric population, focussing a brief on their epidemiology, clinical characteristics, diagnostic modalities, and therapeutic interventions. Through a systematic examination of current literature and clinical case studies, this review aims to elucidate the distinct features and challenges associated with each disorder. Despite the rarity of these conditions, their impact on visual function and quality of life necessitates heightened awareness among clinicians and researchers to facilitate timely diagnosis, appropriate management, and improved outcomes for affected children as their visual systems are still developing. Furthermore, advancements in diagnostic modalities such as fundus fluorescein angiography, optical coherence tomography, electroretinography, and genetic testing are examined for their role in enhancing our understanding of rare pediatric retinal disorders and facilitating early intervention strategies. The literature selection for this article was conducted through PubMed, Google Scholar, and the Cochrane Library databases. A thorough systematic search was carried out for the concerned diseases. Relevant review articles, original research studies, case series, and reports were examined. Additionally, references from these sources were reviewed and included if they provided pertinent information on the topic. The search was not restricted by publication date.
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Affiliation(s)
- Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Birgit Lorenz
- Department of Ophthalmology, University Hospital Bonn, Germany
| | - Snehal Bavaskar
- Medical and Paediatric Retina, Narayana Nethralaya, Karnataka, India
| | | | - Ashley Lopez-Cañizares
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA, United States
| | - Nicholas Fung
- Department of Ophthalmology, Vancouver Acute, University of British Columbia, Canada
| | - Wai Ching Lam
- Department of Ophthalmology, Vancouver Acute, University of British Columbia, Canada
| | - Stephanie M.llop
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA, United States
| | - Shwetha Mangalesh
- Department of Ophthalmology, Duke Eye Institute, Durham, North Carolina, USA, United States
| | - Sengul Ozdek
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Cynthia Toth
- Department of Ophthalmology, Duke Eye Institute, Durham, North Carolina, USA, United States
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4
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Malsch RM, Dalvin LA. A White Reflex in a Previously Healthy 21-Month-Old Boy. Pediatr Rev 2025; 46:e17-e21. [PMID: 40306712 DOI: 10.1542/pir.2024-006581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 12/20/2024] [Indexed: 05/02/2025]
Affiliation(s)
- Rachel M Malsch
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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5
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Forte P, Paques M, Cattaneo J, Dupas B, Castro-Farias D, Girmens JF, Siab M, Biagini F, Nicolò M, Eandi CM, Sacconi R, Querques G. Perifoveal vascular anomalous complex and telangiectatic capillaries: An overview of two entities potentially sharing a common pathophysiology. Surv Ophthalmol 2025; 70:369-379. [PMID: 39824296 DOI: 10.1016/j.survophthal.2025.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 01/09/2025] [Accepted: 01/10/2025] [Indexed: 01/20/2025]
Abstract
Focal capillary ectasia in the macular region can manifest in distinct clinical scenarios, which can be categorized into 2 main entities: perifoveal vascular anomalous complex (PVAC) and telangiectatic capillaries (TelCaps). PVAC represents a primary, idiopathic condition, whereas TelCaps occur secondary to underlying vascular disorders, including diabetic macular edema and retinal vein occlusion. We provide a comprehensive analysis of these 2 entities, encompassing their clinical presentations, multimodal imaging findings, histological evidence, and differential diagnosis from other retinal microvascular abnormalities, such as Type 1 macular telangiectasia, adult-onset Coats disease, Type 3 macular neovascularization in age-related macular degeneration, and retinal arterial macroaneurysms. Although PVAC and TelCaps are distinct entities, they may share common pathogenic mechanisms, including progressive endothelial dysfunction, pericyte loss, and intraluminal deposition of blood components. Selective laser photocoagulation has emerged as a promising therapeutic approach for both conditions. The proposed standardization of nomenclature for accurate reporting and meaningful cross-study comparisons is expected to facilitate future advancements in this field, ultimately leading to improved patient outcomes.
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Affiliation(s)
- Paolo Forte
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Switzerland; IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy; DINOGMI, University of Genoa, Italy
| | - Michel Paques
- Hôpital des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France; FRCRNet/FCRIN Network, Paris, France
| | - Jennifer Cattaneo
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Switzerland
| | - Bénédicte Dupas
- FRCRNet/FCRIN Network, Paris, France; Service d'ophtalmologie, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; Centre Ophtalmologique Sorbonne St Michel, Paris, France
| | - Daniela Castro-Farias
- Hôpital des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France
| | - Jean-François Girmens
- Hôpital des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France
| | - Mehdi Siab
- Hôpital des Quinze-Vingts, Centre d'Investigation Clinique 1423, INSERM, Paris, France
| | - Francesco Biagini
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy; DINOGMI, University of Genoa, Italy
| | - Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy; DINOGMI, University of Genoa, Italy
| | - Chiara Maria Eandi
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Switzerland; Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Elsayed MEA, Lander B, Senthil S, Edward DP, Malik R. The secondary childhood glaucomas. Surv Ophthalmol 2025; 70:544-562. [PMID: 39486644 DOI: 10.1016/j.survophthal.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 10/18/2024] [Accepted: 10/28/2024] [Indexed: 11/04/2024]
Abstract
The secondary childhood glaucomas are a heterogenous group, often associated with other ocular or systemic abnormalities. These childhood glaucomas are distinct from primary childhood glaucomas, both in terms of their clinical features and their response to conventional treatment. Surgical management can be challenging in children with secondary glaucoma. On average, this group undergo more surgical procedures and revisions than those with primary congenital glaucoma. We provide a synopsis of secondary childhood glaucomas in terms of classification, clinical features, and management strategies, with emphasis on recent developments.
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Affiliation(s)
| | | | | | - Deepak P Edward
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Dept of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, USA
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Mavris N, Vofo BN, Khateb S, Levy J. Coats-like vasculopathy in patients with an inherited retinal disease: a case series and literature review. Eye (Lond) 2025:10.1038/s41433-025-03778-2. [PMID: 40169886 DOI: 10.1038/s41433-025-03778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 03/03/2025] [Accepted: 03/20/2025] [Indexed: 04/03/2025] Open
Abstract
OBJECTIVE To examine clinical characteristics, genetic associations, and visual outcomes of Coats-like vasculopathy (CLV) in patients with inherited retinal disease (IRD). METHODS A literature review of studies published through December 30, 2023, and a cohort analysis of cases from Hadassah Medical Center were conducted. Data from 47 studies (163 patients, 277 eyes) and 10 institutional cases (17 eyes) were analysed using descriptive statistics. RESULTS Two novel CLV-associated genes, LRP5 and KIZ, were identified in our cohort. Literature findings showed that 69.9% of cases had bilateral asymmetric CLV, with 38.7% of patients being legally blind at their final assessment. The mean interval between IRD onset and CLV diagnosis was 10.38 ± 10.23 years. While baseline best-corrected visual acuity (BCVA) showed no significant difference between unilateral CLV-affected vs. non-CLV-affected eyes (51.19 vs. 72 ETDRS letters, respectively; p = 0.051), BCVA was significantly different at CLV onset (29.19 vs. 69.12 ETDRS letters, respectively; p < 0.001) and at the final visit (19.93 vs. 63.55 ETDRS letters, respectively; p < 0.001). Visual outcomes were similar across treatment modalities (laser, cryotherapy ± laser). CONCLUSIONS CLV in IRD patients demonstrates clinical and genetic heterogeneity, with significant visual impairment regardless of treatment. The discovery of LRP5 and KIZ expands the genetic landscape of CLV. The profound and progressive vision loss in CLV-affected eyes underscores the need for early detection and tailored management strategies.
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Affiliation(s)
- Neofytos Mavris
- Division of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel
| | - Brice Nguedia Vofo
- Division of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel
| | - Samer Khateb
- Division of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel
| | - Jaime Levy
- Division of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel.
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8
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Bege M, Ghanem Kattoub R, Borbás A. The 20th Anniversary of Pegaptanib (MacugenTM), the First Approved Aptamer Medicine: History, Recent Advances and Future Prospects of Aptamers in Therapy. Pharmaceutics 2025; 17:394. [PMID: 40143057 PMCID: PMC11944999 DOI: 10.3390/pharmaceutics17030394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 03/15/2025] [Accepted: 03/18/2025] [Indexed: 03/28/2025] Open
Abstract
In addition to classic small-molecule drugs and modern protein-based biologics, an intriguing class of medicines is the therapeutic oligonucleotides. Most approved drugs in this category are antisense oligomers or those acting via RNA interference, both of which use base hybridization. Aptamers, also known as chemical antibodies form a smaller, yet equally interesting group of oligonucleotides that can recognize a wide range of molecular targets. Despite their high potential, only two aptamers have been approved to date, pegaptanib (MacugenTM) and avacincaptad pegol (IzervayTM), both for the treatment of age-related macular degeneration (AMD). Targeting vascular endothelial growth factor (VEGF), which plays an important role in the pathogenesis of many eye diseases, pegaptanib emerged as the first anti-VEGF agent and was used in various indications, further inspiring the development of other anti-VEGF therapies. In this review, we summarize the history of the first approved aptamer medicine, pegaptanib. We describe its chemistry and track its development from the earliest stages to the preclinical phase, clinical trials, and eventual regulatory approval. Additionally, we evaluate its position among other therapeutic agents and provide a comprehensive overview of pegaptanib's efficacy, safety, and cost-effectiveness, comparing these aspects with those of monoclonal antibodies with similar indications, bevacizumab and ranibizumab.
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Affiliation(s)
- Miklós Bege
- Department of Pharmaceutical Chemistry, University of Debrecen, Egyetem tér 1, 4032 Debrecen, Hungary; (M.B.); (R.G.K.)
| | - Rasha Ghanem Kattoub
- Department of Pharmaceutical Chemistry, University of Debrecen, Egyetem tér 1, 4032 Debrecen, Hungary; (M.B.); (R.G.K.)
- Doctoral School of Pharmaceutical Sciences, Faculty of Pharmacy, University of Debrecen, Nagyerdei krt. 98., 4032 Debrecen, Hungary
| | - Anikó Borbás
- Department of Pharmaceutical Chemistry, University of Debrecen, Egyetem tér 1, 4032 Debrecen, Hungary; (M.B.); (R.G.K.)
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Selvam A, Gabr H, Chan RP, Heiferman MJ. Coats disease presenting with vitreous hemorrhage and neovascular glaucoma. Am J Ophthalmol Case Rep 2025; 37:102232. [PMID: 39803596 PMCID: PMC11718317 DOI: 10.1016/j.ajoc.2024.102232] [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: 09/06/2024] [Revised: 11/18/2024] [Accepted: 12/07/2024] [Indexed: 01/16/2025] Open
Abstract
Purpose To describe a patient with Coats disease with an atypical presentation of neovascular glaucoma and vitreous hemorrhage. Observations A 15-year-old male presented with five days of pain, redness, and swelling and was found to have neovascular glaucoma in his right eye. Further evaluation revealed Coats disease stage 3AI with a subtotal exudative retinal detachment inferiorly, telangiectatic vessels, and vitreous hemorrhage. Intravitreal anti-vascular endothelial growth factor, laser photocoagulation, pars plana vitrectomy, and valved tube-shunt placement was performed, eventually resulting in a favorable visual outcome. Conclusions and importance We report a patient with a unique presentation of advanced Coats disease. By highlighting the treatment approach and potential factors that led to the preservation of visual function, we hope to expand the literature on the diagnosis and management of Coats disease.
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Affiliation(s)
- Amrish Selvam
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, 60612, USA
| | - Hesham Gabr
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, 60612, USA
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, 60612, USA
| | - Michael J. Heiferman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, 60612, USA
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Godani K, Vidyasagar S, Biradar P, Prabhu V, Hande P, Gandhi P, Kathare R, Chhablani J, Venkatesh R. Coats-Like reaction post-vitreoretinal surgery for PDR managed with laser photocoagulation and adjunctive intravitreal steroids- a case report. BMC Ophthalmol 2025; 25:32. [PMID: 39838351 PMCID: PMC11748534 DOI: 10.1186/s12886-025-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 01/16/2025] [Indexed: 01/23/2025] Open
Abstract
PURPOSE To report a rare case of a Coats-like response developing after vitreoretinal surgery for proliferative diabetic retinopathy (PDR) and its successful management with retinal laser photocoagulation and adjunctive intravitreal steroids. CASE DESCRIPTION A 52-year-old woman with a five-year history of type 2 diabetes mellitus and hypertension presented with decreased vision in the left eye (counting fingers at 1 m). Examination revealed high-risk PDR in both eyes, with a subtotal macula-off combined retinal detachment in the left eye. The patient underwent pan retinal photocoagulation for the right eye and vitreoretinal surgery with silicone oil tamponade for the left eye. Postoperatively, the retina remained attached, but progressive increase in hard exudates in the inferotemporal quadrant was noted in the left eye. Wide-field fluorescein angiography showed temporal capillary dropout and leakage corresponding to the exudates, consistent with a Coats-like response. RESULTS Silicone oil removal combined with targeted endolaser photocoagulation and intravitreal triamcinolone acetonide injection resulted in a complete resolution of the subretinal lipid exudation. Two weeks postoperatively, the retina remained well-attached, but best-corrected visual acuity declined to 6/60 due to posterior subcapsular cataract progression. Optical coherence tomography confirmed the resolution of subretinal lipid exudation, and the patient was advised to undergo cataract surgery. CONCLUSION This case highlights the occurrence of a Coats-like response following vitreoretinal surgery for PDR, potentially triggered by retinal ischemia and surgical inflammation. Timely intervention with laser photocoagulation, and adjunctive intravitreal corticosteroids can effectively manage such responses.
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Affiliation(s)
- Kanika Godani
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Shruti Vidyasagar
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Preksha Biradar
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Vishma Prabhu
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Prathiba Hande
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Priyanka Gandhi
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Rupal Kathare
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India.
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11
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Abatli S, Shweiki SZ. Coats' disease in adulthood with preserved vision after intravitreal aflibercept injection combined with laser photocoagulation : a case report. BMC Ophthalmol 2025; 25:8. [PMID: 39762784 PMCID: PMC11706013 DOI: 10.1186/s12886-024-03829-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 12/23/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND This case report describes a rare case of Coats disease in adult female patient with preserved vision after intravitreal Aflibercept injection and laser photocoagulation. CASE PRESENTATION A female patient of Asian Palestinian descent, aged 20, exhibited a progressive and painless deterioration in the vision of her left eye over a period of two weeks. She exhibited no additional ocular symptoms. Prior to her presentation, she had no notable medical history and her vision was normal in both eyes. Inferotemporal telangiectasia, sausage-like blood vessels with perivascular sheathing in the peripheral fundus, extensive exudate involving the macula, severe macular edema, and localized inferotemporal exudative retinal detachment were observed upon examination of the posterior segment of her left eye. Following this, optical coherence tomography (OCT) identified subretinal exudate, intraretinal and subretinal fluid. After establishing the diagnosis of stage 3 Coats' disease, the patient was treated with intravitreal Aflibercept (Eylea) injections and sectoral laser photocagulation. The third injection resulted in the absence of intraretinal and subretinal fluid by OCT, but the subretinal exudate remained unresolved. One month subsequent to the previous injection, FFA guided sectoral laser photoagulation was applied to the inferiotemporal ischemic area. The patient was subsequently monitored monthly, and her vision improved. Five months after treatment, her vision has improved to 0.7 (6/8.7) and she has remained stable ever since. At present, the patient is undergoing routine outpatient follow-up. CONCLUSION Coats disease is an idiopathic, progressive disease that mostly affects male infants, yet adult cases have been documented. Our case and the existing body of literature indicate that adult individuals have a favorable visual prognosis in the small proportion of cases where this occurs. It appeared that the implementation of intravitreal therapies and increased use of lasers led to enhanced visual outcomes. It is recommended to perform lifelong follow-up to monitor for recurrences and complications.
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Affiliation(s)
- Safaa Abatli
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, PO Box 219, Nablus, State of Palestine.
| | - Sameeha Ziad Shweiki
- Vitreoretinal Surgery Department, Hugo Chavez Hospital, Turmus Ayya, State of Palestine.
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12
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Ucgul AY, Özdek Ş. Coats' Disease: A Comprehensive Review of Its Pathophysiology, Diagnosis, and Advances in Treatment. Semin Ophthalmol 2024:1-16. [PMID: 40094375 DOI: 10.1080/08820538.2024.2447965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 12/15/2024] [Accepted: 12/23/2024] [Indexed: 03/19/2025]
Abstract
BACKGROUND AND PURPOSE Coats' disease, first described by George Coats in 1908, is a rare ocular disorder primarily affecting young males, often unilaterally. It is characterized by retinal telangiectasia, aneurysms, and exudation, which, in severe cases, can lead to blindness, painful red eye, or ocular atrophy, particularly with early childhood onset. Over the last century, advancements have been made in understanding its natural history, morphology, incidence, and clinical manifestations, showing a male predominance without significant ethnic disparities. This review aims to provide a comprehensive overview of Coats' disease, focusing on its pathogenesis, clinical presentation, diagnostic methods, and management strategies. METHODS The pathogenesis of Coats' Disease is multifactorial, involving inflammatory, vascular, and potentially genetic components. Early theories suggested inflammation as the primary cause, but modern research highlights the role of vascular endothelial growth factor (VEGF), where ischemic retinal areas elevate VEGF levels, promoting angiogenesis and impairing the blood-retinal barrier. Clinically, the disease is asymptomatic in early stages but progresses to symptoms like reduced visual acuity, strabismus, and leukocoria, typically within the first decade of life. Diagnostic methods include fundus fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA), with recent studies identifying reduced blood flow density in capillary networks. Management ranges from intravitreal anti-VEGF agents and steroids to surgical options like pars plana vitrectomy and transscleral drainage, with additional techniques such as laser photocoagulation and cryotherapy proving effective in advanced stages. CONCLUSION The prognosis of Coats' Disease heavily depends on the stage of disease at presentation. Early detection and intervention can preserve vision, but advanced stages often result in poor outcomes. Factors such as younger age at presentation, advanced stage, and severe manifestations are associated with more aggressive progression and poorer prognosis. This review highlights the importance of early diagnosis and a multifaceted management approach, emphasizing the need for further research into its pathophysiology and innovative treatment strategies to improve patient outcomes.
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Affiliation(s)
- Ahmet Yucel Ucgul
- Training and Research Hospital, Ahi Evran University, Kırşehir, Turkey
| | - Şengül Özdek
- Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey
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13
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Karuntu JS, Almushattat H, Nguyen XTA, Plomp AS, Wanders RJA, Hoyng CB, van Schooneveld MJ, Schalij-Delfos NE, Brands MM, Leroy BP, van Karnebeek CDM, Bergen AA, van Genderen MM, Boon CJF. Syndromic retinitis pigmentosa. Prog Retin Eye Res 2024; 107:101324. [PMID: 39733931 DOI: 10.1016/j.preteyeres.2024.101324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 12/13/2024] [Accepted: 12/16/2024] [Indexed: 12/31/2024]
Abstract
Retinitis pigmentosa (RP) is a progressive inherited retinal dystrophy, characterized by the degeneration of photoreceptors, presenting as a rod-cone dystrophy. Approximately 20-30% of patients with RP also exhibit extra-ocular manifestations in the context of a syndrome. This manuscript discusses the broad spectrum of syndromes associated with RP, pathogenic mechanisms, clinical manifestations, differential diagnoses, clinical management approaches, and future perspectives. Given the diverse clinical and genetic landscape of syndromic RP, the diagnosis may be challenging. However, an accurate and timely diagnosis is essential for optimal clinical management, prognostication, and potential treatment. Broadly, the syndromes associated with RP can be categorized into ciliopathies, inherited metabolic disorders, mitochondrial disorders, and miscellaneous syndromes. Among the ciliopathies associated with RP, Usher syndrome and Bardet-Biedl syndrome are the most well-known. Less common ciliopathies include Cohen syndrome, Joubert syndrome, cranioectodermal dysplasia, asphyxiating thoracic dystrophy, Mainzer-Saldino syndrome, and RHYNS syndrome. Several inherited metabolic disorders can present with RP, including Zellweger spectrum disorders, adult Refsum disease, α-methylacyl-CoA racemase deficiency, certain mucopolysaccharidoses, ataxia with vitamin E deficiency, abetalipoproteinemia, several neuronal ceroid lipofuscinoses, mevalonic aciduria, PKAN/HARP syndrome, PHARC syndrome, and methylmalonic acidaemia with homocystinuria type cobalamin (cbl) C disease. Due to the mitochondria's essential role in supplying continuous energy to the retina, disruption of mitochondrial function can lead to RP, as seen in Kearns-Sayre syndrome, NARP syndrome, primary coenzyme Q10 deficiency, SSBP1-associated disease, and long chain 3-hydroxyacyl-CoA dehydrogenase deficiency. Lastly, Cockayne syndrome and PERCHING syndrome can present with RP, but they do not fit the abovementioned hierarchy and are thus categorized as miscellaneous. Several first-in-human clinical trials are underway or in preparation for some of these syndromic forms of RP.
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Affiliation(s)
- Jessica S Karuntu
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hind Almushattat
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Xuan-Thanh-An Nguyen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Astrid S Plomp
- Department of Human Genetics, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Ronald J A Wanders
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, the Netherlands; Department of Laboratory Medicine, Laboratory Genetic Metabolic Diseases, Amsterdam UMC, Amsterdam, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mary J van Schooneveld
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, the Netherlands; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marion M Brands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart P Leroy
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium; Department of Head & Skin, Ghent University, Ghent, Belgium; Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Division of Ophthalmology and Center for Cellular and Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Clara D M van Karnebeek
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Arthur A Bergen
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Human Genetics, Section Ophthalmogenetics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maria M van Genderen
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, the Netherlands; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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14
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Tsai ASH, Wang CT, Lee TC, Nagiel A, Matsunaga K, Harper CA, Wood EH, Kim SJ, Hwang S, Shapiro MJ, Blair MP, Toth CA, Valikodath N, Martinez-Castellanos MA, Trese MGJ, Capone A, Drenser K, Tauqeer Z, Besirli CG, Eton E, Hartnett ME, Bair C, Kennedy B, Kusaka S, Mano F, Chang EY, Rao P, Hunt PJ, Walsh MK, Moore S, Sisk RA, Stephenson A, Sears JE, Abraham J, Schulgit M, Vagaggini T, Quiram PA, Vavvas D, Patel NA, Hoyek S, Chan RVP, Challa N, Mendel T, Dewan KS, Rogers DL, Amphornphruet A, Wu WC. Clinical Characteristics and Treatment Outcomes in Unilateral Coats Disease: A Global Collaborative Study. Ophthalmol Retina 2024:S2468-6530(24)00574-8. [PMID: 39613161 DOI: 10.1016/j.oret.2024.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 11/04/2024] [Accepted: 11/21/2024] [Indexed: 12/01/2024]
Abstract
PURPOSE To evaluate the clinical outcomes and prognostic factors in unilateral Coats disease in the era of anti-VEGF therapy. DESIGN Global, multicenter, retrospective case series. SUBJECTS Six hundred fifty-six eyes of 656 subjects with Coats disease were included in this study. Exclusion criteria were Coats disease secondary to retinitis pigmentosa as well as bilateral cases. METHODS Clinical data from patients with Coats disease were collected from 20 ophthalmic practices around the world. We compared early-stage (stage 1-2) and advanced-stage (stage 3-5) Coats disease in terms of clinical characteristics and treatment modalities. MAIN OUTCOME MEASURES Functional outcomes include achieving visual acuity (VA) of 0.3 logarithm of the minimum angle of resolution or better and VA improvement or stability. Anatomical failure was defined as the development of phthisis, chronic retinal detachment, massive fibrosis, or the requirement for enucleation. RESULTS Subjects with early-stage disease were significantly older, with a mean age of 17.4 ± 17.8 years, compared with 7.1 ± 7.1 years in the advanced-stage group (P < 0.001). There was a male predominance in both early and advanced stages (84.7%). Advanced disease was associated with a higher incidence of strabismus (20.2% vs. 6.7%, P < 0.001) and leukocoria (12.3% vs. 3.2%, P < 0.001). More subjects with early-stage disease received laser photocoagulation as monotherapy (44.7% vs. 21.1%, P < 0.001). Additionally, early-stage disease received more sessions of intravitreal anti-VEGF injections as adjunct therapy (4.4 ± 6.2 vs. 2.7 ± 2.1, P = 0.005). Factors associated with poorer functional outcomes included worse presenting VA, advanced disease stage, and the presence of a foveal nodule. Worse presenting VA and advanced disease stage were associated with lower likelihood of anatomical success, whereas combination therapy increased the odds of anatomical success. CONCLUSIONS Unilateral Coats disease predominantly affects males, regardless of disease stage. Identifying a foveal nodule is crucial for visual prognosis. Laser photocoagulation remains the primary treatment. Although anti-VEGF may prevent enucleation, its role in early-stage disease requires further clarification. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Andrew S H Tsai
- Surgical Retina Department, Singapore National Eye Centre, Singapore; DUKE NUS Medical School, Singapore, Singapore
| | - Chung-Ting Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California; Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kate Matsunaga
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - C Armitage Harper
- Austin Retina Associates, Austin, Texas; Department of Ophthalmology, Dell Medical School, Austin, Texas
| | - Edward H Wood
- Austin Retina Associates, Austin, Texas; Department of Ophthalmology, Dell Medical School, Austin, Texas
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | - Cynthia A Toth
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | | | | | | | | | | | | | | | | | | | - Christopher Bair
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brandon Kennedy
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fukutaro Mano
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan
| | | | | | - Patrick J Hunt
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Mark K Walsh
- Retina Associates Southwest and University of Arizona College of Medicine, Arizona
| | - Spencer Moore
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert A Sisk
- Cincinnati Eye Institute, Retina Division, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Department of Pediatric Ophthalmology, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Joseph Abraham
- Cole Eye Institute, The Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | | | - Sandra Hoyek
- Massachusetts Eye and Ear, Boston, Massachusetts
| | | | | | - Thomas Mendel
- Havener Eye Institute-Department of Ophthalmology & Visual Sciences, Columbus, Ohio
| | - Karan Sanjeev Dewan
- Havener Eye Institute-Department of Ophthalmology & Visual Sciences, Columbus, Ohio
| | - David L Rogers
- Havener Eye Institute-Department of Ophthalmology & Visual Sciences, Columbus, Ohio
| | - Atchara Amphornphruet
- Queen Sirikit National Institute of Child Health, Department of Ophthalmology, Bangkok, Thailand
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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15
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Patel KG, Abbey AM. Injectable Fluocinolone Implant for the Management of Cystoid Macular Edema in Coats' Disease. Ophthalmic Surg Lasers Imaging Retina 2024; 55:679-681. [PMID: 39133686 DOI: 10.3928/23258160-20240621-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2024]
Abstract
A six-year-old boy with history of Coats' disease and cystoid macular edema (CME) was treated with a combination of peripheral retinal laser, anti-vascular endothelial grown factor injections, and short-acting injectable steroids to control his disease process. Given the excellent response to shorter acting steroids and the need for general anesthesia for each procedure, the patient underwent placement of the injectable fluocinolone acetonide implant 0.18 mg (YUTIQ) with control of his CME at 30 months of follow-up. The authors conclude that a long-acting steroid implant may be beneficial in select patients with Coats' disease. [Ophthalmic Surg Lasers Imaging Retina 2024;55:679-681.].
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16
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Ferrara M, Jalil A, Moussa G, Ivanova T. UNILATERAL RETINAL NEOVASCULARIZATION ASSOCIATED WITH RECURRENT VITREOUS HEMORRHAGE IN A PATIENT WITH GYRATE ATROPHY. Retin Cases Brief Rep 2024; 18:762-765. [PMID: 37748437 DOI: 10.1097/icb.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND/PURPOSE To describe the first case of unilateral peripheral retinal neovascularization associated with recurrent vitreous hemorrhage and localized tractional retinal detachment in a patient with gyrate atrophy. METHODS Interventional case report. RESULTS A 23-year-old man with confirmed diagnosis of gyrate atrophy presented with vitreous hemorrhage and history of stable peripheral inferior tractional retinal detachment in the left eye. After 3 months, the vitreous hemorrhage partially reabsorbed and peripheral retinal vascular abnormalities with focal neovascularization were detected with associated tractional retinal detachment and confirmed on fluorescein angiography. Cryotherapy was performed to prevent any further bleeding. Twelve months later, the left eye remained stable and no further vitreous bleeding occurred. CONCLUSION The combination of peripheral retinal neovascularization, localized tractional retinal detachment, and recurrent vitreous hemorrhage can be a unilateral complication of gyrate atrophy. In similar cases, cryotherapy may represent a valuable therapeutic option to prevent recurrent bleeding.
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Affiliation(s)
- Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; and
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; and
| | - George Moussa
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; and
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17
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Anastasia R, Yustiarini I, Prakosa AD, Widjaja SA, Firmansjah M, Sasono W. Late presentation of Coats disease in a 12-year-old boy: a case report. Pan Afr Med J 2024; 49:36. [PMID: 39886112 PMCID: PMC11781208 DOI: 10.11604/pamj.2024.49.36.45134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 10/05/2024] [Indexed: 02/01/2025] Open
Abstract
Coats disease is a rare abnormality characterized with retinal telangiectasia and aneurysms with retinal exudation, most often seen in young males and usually affecting only one eye. A 12-year-old boy came in with a three-month history of vision loss and pain in his right eye, alongside progressively worsening blurred vision over the last year. His visual acuity was reduced to only light perception in the right eye, while his left eye maintained 5/5 vision. The intraocular pressure was 43.4 mmHg in the right eye and 15 mmHg in the left eye. Conjunctival hyperaemia, mild corneal edema, iris neovascularization, xantocoria, and dilated pupil was found in anterior segment. Ophthalmoscopy showed retinal telangiectasia in all quadrants and total bullous exudative retinal detachment. Coats disease cases that present at an advanced stage have fewer treatment options and generally a worse prognosis.
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Affiliation(s)
- Ruth Anastasia
- Department of Ophthalmology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
| | - Ima Yustiarini
- Department of Ophthalmology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
| | - Ady Dwi Prakosa
- Department of Ophthalmology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
| | - Sauli Ari Widjaja
- Department of Ophthalmology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
| | - Muhammad Firmansjah
- Department of Ophthalmology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
| | - Wimbo Sasono
- Department of Ophthalmology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
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18
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Panirsheeluam B, Abd Ghani S, Mohamad Isa MI, Alexander SM, Che Hamzah J, Chee CT, Hoong CK. Family of juvenile X-linked retinoschisis with varied presentation: a case series with RS1 genetic analysis. J AAPOS 2024; 28:104006. [PMID: 39304024 DOI: 10.1016/j.jaapos.2024.104006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 09/22/2024]
Abstract
RS1 gene mutations are known to be a direct cause of the hereditary retinopathy known as retinoschisis. We describe a group of 3 siblings with the same RS1 gene mutation who presented with different retinopathy phenotypes. Genetic testing confirmed the RS1 genotypes. Clinical ophthalmoscopy, color fundus photography, optical coherence tomography, and fundus fluorescein angiography identified manifestations of Coats-like exudative vitreoretinopathy, retinal detachment, and retinoschisis.
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Affiliation(s)
| | - Shuaibah Abd Ghani
- Ophthalmology, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Malaysia
| | | | | | - Jemaima Che Hamzah
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Cheng Teck Chee
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Chan Kwok Hoong
- Ophthalmology, Hospital Wanita dan Kanak-Kanak, Sabah, Malaysia
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19
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Altamirano F, Gonzalez E, Shah AS, Oke I. Preventable vision loss in children with Coats disease. J AAPOS 2024; 28:104000. [PMID: 39278531 PMCID: PMC11532007 DOI: 10.1016/j.jaapos.2024.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE To describe the prevalence and risk factors associated with amblyogenic refractive error in children with Coats disease. METHODS The medical records of children (<18 years of age) with unilateral Coats disease treated at a single tertiary care center were retrospectively reviewed. Data collected included patient demographics, ocular examinations, and treatments. Outcomes included the prevalence and factors associated with amblyogenic refractive error. RESULTS A total of 50 children (82% male) were included; of these, 37 (74%) had refractive data to review. The median age at presentation was 5 years (IQR, 2-10). The Coats disease classification was stage 1 in 1 (2%), stage 2 in 29 (58%), and stage 3 or greater in 20 (40%). Most children (76%) had at least one visit with a pediatric specialist; the rest were only seen by a retina specialist. Among patients with refractive data, amblyogenic refractive error was identified in 46%. Glasses were prescribed to 50% of children. Children diagnosed at an earlier age had increased odds of amblyogenic refractive error (OR = 0.72; 95% CI, 0.57-0.91; P = 0.006) than those diagnosed at an older age. CONCLUSIONS Our results suggest that amblyogenic refractive error is prevalent among children with Coats disease, and refractions are not always performed. There is a need to coordinate care between pediatric and retina specialists caring for children with Coats disease to ensure timely diagnosis of amblyogenic refractive error to optimize visual outcomes in this population.
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Affiliation(s)
- Francisco Altamirano
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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20
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Jung S, Woo SJ. Ultra-Widefield Fluorescein Angiographic Features Influencing Visual Prognosis in Coats Disease. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:413-423. [PMID: 39205471 PMCID: PMC11491800 DOI: 10.3341/kjo.2024.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/20/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE To investigate the retinal vascular abnormalities in both affected and fellow eyes of presumed unilateral Coats disease patients using ultra-widefield fluorescein angiography (UWF-FA) and their association with visual prognosis. METHODS A retrospective review of medical records was conducted on 30 patients diagnosed with presumed unilateral Coats disease, who were evaluated with UWF-FA from March 2003 to May 2024 at a tertiary referral hospital. Clinical features and multimodal imaging findings were evaluated, and factors related to final visual outcomes were analyzed. RESULTS All 30 patients were diagnosed with presumed unilateral Coats disease at presentation, comprising 11 childhood-onset (36.7%) and 19 adult-onset patients (63.3%). Retinal vascular telangiectasia was observed in 51.7% of the fellow eyes. The extent of telangiectasia and exudate in the affected eyes did not significantly correlate with the extent of telangiectasia in the fellow eyes. In the more affected eyes, the childhood-onset group had a significantly greater extent of capillary dropout compared to the adult-onset group (5.0 clock hours vs. 2.8 clock hours, p = 0.023). In the fellow eyes, telangiectasia tended to be more frequent in the childhood-onset group, without statistical significance (63.6% vs. 44.4%, p = 0.160). In the multivariable regression analysis, the final best-corrected visual acuity (BCVA) in the more affected eyes was significantly associated with initial BCVA. The mean extent of telangiectasia in the temporal and nasal quadrants (odds ratio, 12.759; p = 0.043) and the initial BCVA of the more affected eyes (odds ratio, 11.841; p = 0.024) were identified as prognostic factors for final moderate to severe visual loss (Snellen BCVA <20 / 66). CONCLUSIONS About half of the presumed unilateral Coats disease cases exhibited features of the bilateral disease. Visual prognosis is associated with the peripheral retinal telangiectasia in the temporal and nasal quadrants as well as initial BCVA in the affected eyes while it is not associated with retinal vascular abnormalities in the fellow eyes.
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Affiliation(s)
- Sangwon Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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Low CX, Mohamed SO, Zahari M. Eales' disease with secondary coats'-like reaction: a case report. BMC Ophthalmol 2024; 24:420. [PMID: 39333939 PMCID: PMC11437731 DOI: 10.1186/s12886-024-03668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Eales' disease is an idiopathic, inflammatory condition characterized by peripheral retinal phlebitis, distal non-perfusion, and neovascularization. Coats' disease, on the other hand, is an idiopathic, retinal vasculopathy characterized by telangiectasia and yellowish exudation. Both diseases commonly affect males. Here, we report an atypical case of unilateral Eales' disease with co-existing, secondary Coats'-like reaction in a 25-year-old male exhibiting unilateral retinal telangiectasia accompanied by subtle macular edema, extensive peripheral vascular sheathing, and distal non-perfusion in the absence of clinically visible exudation. METHODS Case report. RESULTS A 25-year-old male presented with painless blurring of vision in the right eye for two months. Best-corrected Snellen visual acuity was 3/60 in the affected eye, with relative afferent pupillary defect observed, and 6/9 contralaterally. Anterior segment examination was unremarkable. Right eye fundoscopy showed aneurysmal telangiectasia at the macula, 360 degrees perivascular sheathing and telangiectasia of peripheral retinal vessels. There was no exudation, neovascularization, tractional membranes, vitritis, retinitis, and choroiditis. Left eye fundus was unremarkable. Optical coherence tomography of the macula revealed disorganization and thinning of the inner retinal layers with minimal intraretinal fluid. Fundus fluorescein angiography showed leakage from the aneurysms but not from the sheathed vessels, and an enlarged foveolar avascular zone. A well-defined zone of non-perfusion and retinal vascular telangiectasia with shunts was observed. Blood investigations ruled out metabolic, infectious, haematological, and autoimmune causes. Carotid Doppler showed no stenosis, and CT angiography of the brain did not show any vascular abnormalities. In view that no cause was identified, a diagnosis of Eales' disease with secondary Coats'-like reaction was made. Treatment consisted of FFA-guided laser photocoagulation to the areas of non-perfusion. Intavitreal anti-vascular endothelial growth factor injection was not done in view of poor visual prognosis. The condition and visual acuity remained stable during 18 months of follow-up. CONCLUSION This report highlights an atypical case of Eales' disease with co-existing, secondary Coats'-like reaction.
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Affiliation(s)
- Chien Xue Low
- Department of Ophthalmology, Faculty of Medicine, 1UM Eye Research Centre (UMERC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shelina Oli Mohamed
- 2Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
| | - Mimiwati Zahari
- Department of Ophthalmology, Faculty of Medicine, 1UM Eye Research Centre (UMERC), Universiti Malaya, Kuala Lumpur, Malaysia
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22
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Santos Oliveira J, Catarino S, Magalhães A, Rocha G, Santos Silva R. The Red Reflex Test and Leukocoria in Childhood. ACTA MEDICA PORT 2024; 37:638-646. [PMID: 39074051 DOI: 10.20344/amp.21367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/20/2024] [Indexed: 07/31/2024]
Abstract
The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.
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Affiliation(s)
| | - Sara Catarino
- Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal
| | - Augusto Magalhães
- Department of Ophthalmology & Reference Centre of Inherited Metabolic Diseases at the Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal
| | - Gustavo Rocha
- Department of Neonatology. Unidade Local de Saúde de São João. Porto. Portugal
| | - Renato Santos Silva
- Department of Ophthalmology. Unidade Local de Saúde de São João. Porto.; Department of Surgery and Physiology. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Zhou W, Zhou H, Liu YY, Li MX, Wu XH, Liang J, Hao J, Liu SN, Jin CJ. Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease. Int J Ophthalmol 2024; 17:1469-1476. [PMID: 39156792 PMCID: PMC11286439 DOI: 10.18240/ijo.2024.08.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/19/2024] [Indexed: 08/20/2024] Open
Abstract
AIM To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. METHODS This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. RESULTS The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield's staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. CONCLUSION Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.
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Affiliation(s)
- Wei Zhou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hui Zhou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yuan-Yuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Meng-Xuan Li
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiao-Han Wu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jiao Liang
- Department of Ophthalmology, Shanxi Yuncheng Tongde Hospital, Yuncheng 044000, Shanxi Province, China
| | - Jing Hao
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Sheng-Nan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chun-Jie Jin
- Department of Information, Tianjin Medical University General Hospital, Tianjin 300052, China
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Stephen M, Temkar S, Periyandavan J, Basa K. A Brief Review on Adult-Onset Coats' Disease. Rom J Ophthalmol 2024; 68:212-218. [PMID: 39464770 PMCID: PMC11503233 DOI: 10.22336/rjo.2024.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2024] [Indexed: 10/29/2024] Open
Abstract
Adult-onset Coats disease is an uncommon and vision-threatening disease characterized by the development of abnormal blood vessels in the retina. Coats' disease commonly affects children in the first decade of life, but very rarely manifests in adults after the third decade of life, or who characteristically present with unilateral vision loss. Despite being a sight-threatening disease, the etiology remains inconclusive and various genetic and vascular abnormalities are implicated. Diagnosis relies on ophthalmologic examination, fundus photography, fluorescein angiography, and optical coherence tomography. Treatment modalities include laser photocoagulation, intravitreal injections of anti-vascular endothelial growth factor agents, and, in advanced cases, surgical interventions are needed and the treatment is aimed at avoiding complications like retinal detachment and neovascular glaucoma, which were comparatively rare in adult-onset Coats' disease. Despite therapeutic advancements, the prognosis varies, with some patients experiencing significant visual impairment. This review outlines the clinical features, diagnosis, management, and prognosis of adult-onset Coats' disease, underscoring the importance of early detection and intervention in optimizing visual outcomes.
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Affiliation(s)
- Mary Stephen
- Department of Ophthalmology, JIPMER, Puducherry, India
| | | | | | - Kalyan Basa
- Department of Ophthalmology, JIPMER, Puducherry, India
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Gerrie SK, Rajani H, Branson HM, Lyons CJ, Marie E, Frayn CS, Hughes ECM, Navarro OM. Pediatric orbital lesions: ocular pathologies. Pediatr Radiol 2024; 54:876-896. [PMID: 38321238 DOI: 10.1007/s00247-024-05869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.
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Affiliation(s)
- Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher J Lyons
- Department of Ophthalmology, BC Children's Hospital, Vancouver, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Oscar M Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Yiu G, Hang A, Fong R. Surgical Drainage of Large Macular Cystoid Spaces in Coats Disease. JOURNAL OF VITREORETINAL DISEASES 2024; 8:355-358. [PMID: 38770082 PMCID: PMC11102732 DOI: 10.1177/24741264241240320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To describe an option of surgically draining large macular cystoid spaces in a patient with Coats disease. Methods: A case and its findings were analyzed. Results: A standard pars plana vitrectomy was performed to aspirate large macular cystoid spaces using a subretinal cannula with intraoperative optical coherence tomography guidance. Because of the viscous nature of the chronic fluid and lipid exudates, the contents of the large cystoid spaces were drained through a retinotomy using a soft-tipped aspiration cannula. Postoperative follow-up after surgical drainage showed immediate resolution of the macular cystoid spaces and gradual resolution of the dense subfoveal exudates over 1 year. Although surgical intervention led to the eventual resolution of the macular edema and exudates, visual recovery was limited by the chronicity of the condition. Conclusions: Surgical drainage of large macular cystoid spaces in Coats disease can be achieved in eyes that are refractory to medical management. Earlier surgical intervention in select cases may allow for visual rehabilitation.
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Affiliation(s)
- Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Abraham Hang
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Rodney Fong
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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Guarnera A, Valente P, Pasquini L, Moltoni G, Randisi F, Carducci C, Carboni A, Lucignani G, Napolitano A, Romanzo A, Longo D, Gandolfo C, Rossi-Espagnet MC. Congenital Malformations of the Eye: A Pictorial Review and Clinico-Radiological Correlations. J Ophthalmol 2024; 2024:5993083. [PMID: 38322500 PMCID: PMC10846927 DOI: 10.1155/2024/5993083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/23/2023] [Accepted: 11/10/2023] [Indexed: 02/08/2024] Open
Abstract
Congenital malformations of the eye represent a wide and heterogeneous spectrum of abnormalities that may be part of a complex syndrome or be isolated. Ocular malformation severity depends on the timing of the causative event during eye formation, ranging from the complete absence of the eye if injury occurs during the first weeks of gestation, to subtle abnormalities if the cause occurs later on. Knowledge of ocular malformations is crucial to performing a tailored imaging protocol and correctly reporting imaging findings. Together with the ophthalmologic evaluation, imaging may help frame ocular malformations and identify underlying genetic conditions. The purpose of this pictorial review is to describe the imaging features of the main ocular malformations and the related ophthalmologic findings in order to provide a clinico-radiological overview of these abnormalities to the clinical radiologist. Sight is a crucial sense for children to explore the world and relate with their parents from birth. Vision impairment or even blindness secondary to ocular malformations deeply affects children's growth and quality of life.
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Affiliation(s)
- Alessia Guarnera
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Paola Valente
- Ophthalmology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York 10065, NY, USA
| | - Giulia Moltoni
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Francesco Randisi
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Chiara Carducci
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Alessia Carboni
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Giulia Lucignani
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonino Romanzo
- Ophthalmology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Carlo Gandolfo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
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Li L, Li S, Liu J, Deng G, Ma J, Lu H. Long-term efficacy and complications of intravitreal anti-vascular endothelial growth factor agents combined with ablative therapies in juvenile Coats disease: a five year follow-up study. Graefes Arch Clin Exp Ophthalmol 2024; 262:305-312. [PMID: 37421483 DOI: 10.1007/s00417-023-06162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE To evaluate the long-term safety and efficacy of adjuvant intravitreal anti-VEGF therapy in juvenile Coats disease. METHODS This retrospective, observational study included a total of 62 eyes in 62 pediatric patients with juvenile Coats disease treated with intravitreal anti-VEGF agents followed for a mean of 67.08 months (ranged from 60 to 93 months). All affected eyes were managed initially with one session of ablative treatment plus adjuvant intravitreal anti-VEGF agent (0.5 mg/0.05 ml ranibizumab or conbercept). Ablative treatment was repeated if telangiectatic retinal vessels were not completely regressed or recurred. Anti-VEGF therapy was repeated if subretinal fluid or macular edema still existed. Treatments above were repeated every 2 to 3 months. We reviewed clinical and photographic records of patients including the demographics, clinical characteristics and interventions. RESULTS At final visit, all 62 affected eyes had partially or completely disease resolution; none progressed to advanced stage namely neovascular glaucoma or phthisis bulbi, respectively. No ocular or systemic side effects related to intravitreal injections were observed during follow-up. In terms of 42 affected eyes that could cooperate with visual examination, best corrected visual acuity improved in 14 (14/42, 33.3%) eyes, stabled in 25 (25/42, 59.5%) eyes, and worsened in 3 (3/42, 7.1%) eyes. In the field of complications, 22 (22/62, 35.5%) eyes developed cataracts; 33 (33/62, 53.2%) eyes developed vitreoretinal fibrosis, of whom 14 (14/33, 42.4%) eyes in the subgroup of stage 3B developed progressive TRD; 40 (40/62, 64.5%) eyes developed subretinal fibrosis. Multivariate regression analysis showed increased clinical stage may be associated with the development of vitreo- and subretinal fibrosis (adjusted odds ratio:16.77,17.59; 95% CI:4.50-62.53, 3.98-77.86, respectively, all P < 0.001). CONCLUSION Adjuvant intravitreal ranibizumab or conbercept combined with ablative therapies may be a long-term safe and effective treatment for juvenile Coats disease.
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Affiliation(s)
- Liang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Songfeng Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Jinghua Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Guangda Deng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jing Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Hai Lu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.
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Berco E, Elsliger S, Weinberg T, Ghannam W, Shoham-Hazon N. Triple Trouble with Triple Solutions: A Unique Case Report of a Severe Exudative Retinal Detachment Accompanied by Retinal Traction and Two Retinal Holes in Coats Disease. Case Rep Ophthalmol 2024; 15:84-91. [PMID: 38288027 PMCID: PMC10824515 DOI: 10.1159/000535821] [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: 10/10/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Coats disease is a rare vasculature pathology that usually presents as retinal telangiectasia with possible progression to exudative retinal detachment (RD). Intravitreal anti-VEGF injections, cryotherapy, laser photocoagulation, and surgery are commonly used to control the disease and prevent its progression. Although iatrogenic tractional RDs secondary to anti-VEGF injections have been reported in patients with Coats disease, RDs in Coats disease are exudative, secondary to retinal exudation and vascular abnormalities. In this article, we present the first reported case of a severe exudative RD accompanied by retinal traction and two retinal holes in a patient with Coats disease. Case Presentation A 32-year-old male initially presented with Coats disease stage 2A, which then progressed to 3A1 within a month of close follow-ups, finally leading to exudative RD. Following cryotherapy and bevacizumab injections, the exudative RD progressed, with the emergence of retinal traction and two retinal holes. This complex case was successfully treated with a scleral buckle vitrectomy accompanied by radial elements to support the RD, pars plana vitrectomy, silicon oil tamponade, and post-surgical bevacizumab injections. Six months following the surgical intervention, the patient's vision is restored at 20/30, and retinal imaging shows a totally flattened retina. Conclusion We present the first reported case of a severe exudative RD accompanied by retinal traction and two retinal holes in a patient with Coats disease. The combination of surgical treatment and bevacizumab injections is thought to have collectively contributed to our patient's favorable outcome.
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Affiliation(s)
- Efraim Berco
- Department of Ophthalmology, Hadassah University, Rehovot, Israel
| | - Simon Elsliger
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamir Weinberg
- Department of Ophthalmology, Hadassah University, Rehovot, Israel
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, NB, Canada
| | - Waleed Ghannam
- Department of Ophthalmology, Hadassah University, Rehovot, Israel
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, NB, Canada
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Laasri K, El houss S, Halfi IM, Kettani NEC, Fikri M, Jiddane M, Taoursa F. Coats' syndrome: A rare cause of infant leukocoria to keep in mind. Radiol Case Rep 2024; 19:7-11. [PMID: 37881471 PMCID: PMC10594555 DOI: 10.1016/j.radcr.2023.09.046] [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: 07/30/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
Leukocoria is an aberration of the eyeball that interferes with normal reflection. It shows up as a white or gray pupillary reflex rather than the bright red or orange pupil of the other eye. Leukocoria can be brought on by a variety of ocular pathologies, with retinoblastoma being the most common. We present the case of a 17-month-old guy who had unilateral leukocoria and whose orbital MRI was ordered on the basis of retinoblastoma suspicion. The results, however, were more suggestive of Coats disease than retinoblastoma. Telangiectasia and exudate, which frequently afflict males' unilateral eyes, are the hallmarks of Coats' illness. Depending on the stage of the disease, there are differences in its severity, course, and outlook. It is crucial to get therapy and a diagnosis for retinal problems as soon as possible. Although uncommon, there are still many people who are not familiar with Coats' disease. This paper aims to describe imaging findings in Coats' disease.
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Affiliation(s)
- Khadija Laasri
- Neuroradiology Department, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Salma El houss
- Neuroradiology Department, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Ismail Mohamed Halfi
- Neuroradiology Department, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | | | - Meryem Fikri
- Neuroradiology Department, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Mohamed Jiddane
- Neuroradiology Department, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Firdaous Taoursa
- Neuroradiology Department, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
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Daich Varela M, Conti GM, Malka S, Vaclavik V, Mahroo OA, Webster AR, Tran V, Michaelides M. Coats-like Vasculopathy in Inherited Retinal Disease: Prevalence, Characteristics, Genetics, and Management. Ophthalmology 2023; 130:1327-1335. [PMID: 37544434 PMCID: PMC10937259 DOI: 10.1016/j.ophtha.2023.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023] Open
Abstract
PURPOSE To describe the largest, most phenotypically and genetically diverse cohort of patients with inherited retinal disease (IRD)-related Coats-like vasculopathy (CLV). DESIGN Multicenter retrospective cohort study. PARTICIPANTS A total of 67 patients with IRD-related CLV. METHODS Review of clinical notes, ophthalmic imaging, and molecular diagnosis from 2 international centers. MAIN OUTCOME MEASURES Visual function, retinal imaging, management, and response to treatment were evaluated and correlated. RESULTS The prevalence of IRD-related CLV was 0.5%; 54% of patients had isolated retinitis pigmentosa (RP), 21% had early-onset severe retinal dystrophy, and less frequent presentations were syndromic RP, sector RP, cone-rod dystrophy, achromatopsia, PAX6-related dystrophy, and X-linked retinoschisis. The overall age of patients at CLV diagnosis was 30.7 ± 16.9 years (1-83). Twenty-one patients (31%) had unilateral CLV, and the most common retinal features were telangiectasia, exudates, and exudative retinal detachment (ERD) affecting the inferior and temporal retina. Macular edema/schisis was observed in 26% of the eyes, and ERD was observed in 63% of the eyes. Fifty-four patients (81%) had genetic testing, 40 of whom were molecularly solved. Sixty-six eyes (58%) were observed, 17 eyes (15%) were treated with a single modality, and 30 eyes (27%) had a combined approach. Thirty-five eyes (31%) were "good responders," 42 eyes (37%) were "poor responders," 22 eyes (19%) had low vision at baseline and were only observed, and 12 eyes (11%) did not have longitudinal assessment. Twenty-one observed eyes (62%) responded well versus 14 (33%) treated eyes. Final best-corrected visual acuity was significantly worse than baseline (P = 0.002); 40 patients (60%) lost 15 ETDRS letters or more over follow-up in 1 or both eyes, and 21 patients (31%) progressed to more advanced stages of visual impairment. CONCLUSIONS Inherited retinal disease-related CLV is rare, sporadic, and mostly bilateral; there is no gender predominance, and it can occur in diverse types of IRD at any point of the disease, with a mean onset in the fourth decade of life. Patients with IRD-related CLV who have decreased initial visual acuity, ERD, CLV changes affecting 2 or more retinal quadrants, and CRB1-retinopathy may be at higher risk of a poor prognosis. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | | | | | | | - Omar A Mahroo
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Andrew R Webster
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Viet Tran
- Hôpital Ophtalmique Jules-Gonin, Lausanne, Switzerland
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
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Aygun B, Biswas A, Taranath A, Yildiz H, Gore S, Mankad K. Neuroimaging of Ocular Abnormalities in Children. Neuroimaging Clin N Am 2023; 33:623-641. [PMID: 37741662 DOI: 10.1016/j.nic.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
In this article, we will discuss the essential MR imaging protocol required for the assessment of ocular abnormalities including malignancies. Then we will describe relevant anatomy, ocular embryogenesis, and genetics to establish a profound understanding of pathophysiology of the congenital ocular malformations. Finally, we will discuss pediatric ocular malignancies, benign mimics, and the most common congenital ocular malformations with case examples and illustrations and give tips on how to distinguish these entities on neuroimaging.
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Affiliation(s)
- Berna Aygun
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK; Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Asthik Biswas
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, South Australia Medical Imaging, University of Adelaide, South Australia, Australia
| | - Harun Yildiz
- Department of Radiology, Bursa Dortcelik Children's Hospital, Bursa, Turkey
| | - Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL GOS Institute of Child Health
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Świerczyńska M, Tronina A, Lorenc A, Filipek E. Anterior Uveitis and Coats Disease in a 16-Year-Old Girl with Noonan Syndrome-A Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1643. [PMID: 37892306 PMCID: PMC10605920 DOI: 10.3390/children10101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Background: Noonan syndrome (NS) represents a fairly common genetic disorder with a highly variable phenotype. Its features include inherited heart defects, characteristic facial features, short stature, and mild retardation of motor skills. Case presentation: A 16-year-old Caucasian girl with NS reported visual deterioration, photophobia, and pain in the right eye (RE). The initial best-corrected visual acuity (BCVA) was 0.3 in the RE. An examination demonstrated conjunctival and ciliary body hyperemia, keratic precipitates, and flare in the anterior chamber. In addition, post-hemorrhagic floaters, tortuous vessels, and an epiretinal membrane in the RE were present. Diagnosis of unilateral anterior uveitis was made, and this resolved after the use of topical steroids and cycloplegic drops. Due to the presence of retinal telangiectasias and extraocular exudates (consistent with Coats' disease (CD) stage 2A) in the RE, laser therapy was performed. The patient remains under constant follow-up, and after one year, the BCVA in the RE was 0.7. Conclusions: Here, we report the clinical characteristics, genetic findings, and retinal imaging results of a patient with NS. To our knowledge, this is, to date, the first report of an association of NS with a PTPN11 mutation with anterior uveitis and CD.
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Affiliation(s)
- Marta Świerczyńska
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-055 Katowice, Poland
| | - Agnieszka Tronina
- Department of Pediatric Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland (E.F.)
- Department of Pediatric Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Lorenc
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-055 Katowice, Poland
| | - Erita Filipek
- Department of Pediatric Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland (E.F.)
- Department of Pediatric Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-055 Katowice, Poland
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Bai J, Song Z, Li G, Dong L, Zhang C. Efficacy and Safety of Anti-Vascular Endothelial Growth Factor Drugs for Coats' Disease Treatment: A Systematic Review. J Ocul Pharmacol Ther 2023; 39:418-429. [PMID: 37504967 DOI: 10.1089/jop.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Purpose: The efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) treatment for Coats' disease remains controversial. This study was designed to evaluate the efficacy and safety of anti-VEGF treatment for Coats' disease. Methods: PubMed, Embase, The Cochrane Library, Clinical Trials, CNKI, and WanFang databases were systematically searched for clinical efficacy and safety studies on anti-VEGF treatment for Coats' disease through June 2021. Study selection, data extraction, and quality assessment were independently performed by 2 reviewers. Quality assessments were performed using the Joanna Briggs Institute Critical Appraisal tools and GRADE-CERQual. Results: A total of 1,501 articles were retrieved and reviewed, of which 24 case series involving 378 patients (range: 3-67 patients each with 3-71 eyes) were included in the analysis. No randomized controlled trials, case-controlled studies, or cohort studies were available for analysis. Most patients were male (60.0%-92.9%), aged 1.35-42.3 years, with a median follow-up time ranging from 3 to 63 months. Among the 24 case series, 22 reported changes in the visual acuity (VA) after anti-VEGF treatment and 21 reported safety outcomes. The results showed that VA improved in 73 patients (37.63%), was stable in 89 (45.87%), and worsening VA was observed in 12 cases (6.19%). The most common adverse event was fibrotic changes (n = 35). Systemic complications were not observed. Conclusions: The results of this study indicate that anti-VEGF drugs provide an effective and relatively safe treatment strategy for Coats' disease. However, conducting well-designed, prospective, randomized clinical trials are necessary to confirm our findings.
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Affiliation(s)
- Jie Bai
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhihui Song
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guangyao Li
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liming Dong
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chao Zhang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
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Yadav G, Singh A, Kushwaha R, Verma N, Srivastava RM, Singh US. Utility of bone marrow examination in retinoblastoma and their correlation with hematological features. J Med Life 2023; 16:1245-1250. [PMID: 38024824 PMCID: PMC10652682 DOI: 10.25122/jml-2023-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 12/01/2023] Open
Abstract
Retinoblastoma makes up about 3% of all childhood malignancies. The frequency of metastatic retinoblastoma ranges from 4.8 to 11%. Assessing the bone marrow status of newly diagnosed patients is crucial because of the advantages of autologous bone marrow transplants for high-risk patients. This study aimed to determine the utility of bone marrow examination in cases of retinoblastoma and its correlation with hematological findings. This retrospective study was conducted at the Department of Pathology, King George's Medical University, Lucknow, India. A total of 34 cases of retinoblastoma with bone marrow examination were included in the study. Bone marrow infiltration was present in 17.65% (6/34) cases of retinoblastoma. Bone marrow aspirate myelogram showed that marrow metastasis in retinoblastoma was significantly linked with a reduced percentage of total myeloid cells (p=0.001) and segmented cells (p=0.006). The present study demonstrated that 15% (3/20) of retinoblastoma patients previously classified as nonmetastatic before bone marrow examination (stages I to III based on histology, imaging, and bone scan) had bone marrow metastases following bone marrow examination and were upgraded to stage IV. To conclude, a diligent and exhaustive search for metastatic cells in bone marrow is advised if the myelogram shows a reduced percentage of total myeloid and segmented cells. All stage II and stage III cases of retinoblastoma must undergo bone marrow examination for early metastasis detection, as it may result in an upgrade to stage IV disease, impacting the prognosis and necessitating distinct treatment modalities.
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Affiliation(s)
- Geeta Yadav
- Department of Pathology, King George’s Medical University Lucknow, India
| | - Anurag Singh
- Department of Pathology, King George’s Medical University Lucknow, India
| | - Rashmi Kushwaha
- Department of Pathology, King George’s Medical University Lucknow, India
| | - Nishant Verma
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | | | - Uma Shankar Singh
- Department of Pathology, King George’s Medical University Lucknow, India
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Pedroso LA, Costa FV, Silva AGE, da Silva JRDM, Biancardi AL, Curi ALL. Acute ocular toxoplasmosis presenting as a retinal angiomatous lesion. Arq Bras Oftalmol 2023; 86:294. [PMID: 37283376 PMCID: PMC11826552 DOI: 10.5935/0004-2749.2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Leticia Alcântara Pedroso
- Laboratory of Infectious Diseases in Ophthalmology, National
Institute of Infectology, Fundação Oswaldo Cruz, Rio de Janeiro, RJ,
Brazil
| | - Flavia Veiga Costa
- Laboratory of Infectious Diseases in Ophthalmology, National
Institute of Infectology, Fundação Oswaldo Cruz, Rio de Janeiro, RJ,
Brazil
| | - Amanda Gomes e Silva
- Laboratory of Infectious Diseases in Ophthalmology, National
Institute of Infectology, Fundação Oswaldo Cruz, Rio de Janeiro, RJ,
Brazil
| | | | - Ana Luiza Biancardi
- Laboratory of Infectious Diseases in Ophthalmology, National
Institute of Infectology, Fundação Oswaldo Cruz, Rio de Janeiro, RJ,
Brazil
| | - André Luiz Land Curi
- Laboratory of Infectious Diseases in Ophthalmology, National
Institute of Infectology, Fundação Oswaldo Cruz, Rio de Janeiro, RJ,
Brazil
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Caldrer S, Deotto N, Pertile G, Bellisola G, Guidi MC. Infrared analysis in the aqueous humor of patients with uveitis: Preliminary results. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 243:112715. [PMID: 37126864 DOI: 10.1016/j.jphotobiol.2023.112715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
Inflammatory processes affecting the uvea result in a temporary o permanent blurred vision and represent an important cause of visual impairment worldwide. It is often hard to make a precise diagnosis which is dependent on the clinical expertise, diagnostic tests, laboratory investigations in blood and sometimes in the aqueous humor (AH). With the aim of obtaining proof of principle Fourier Transformed Infrared (FT-IR) absorbance spectroscopy was applied to study the molecular composition of 72 AH samples collected in 26 patients with uveitis and in 44 controls. The unsupervised exploration of the internal structure of the dataset by principal component analysis reduced hundreds IR variables to those most representative allowing to obtain the predictive model that distinguished the AH spectra of patients with uveitis from controls. The same result was obtained by unsupervised agglomerative cluster analysis. After labeling the spectra with some clinical information it was observed that most severe uveitis with active processes were grouped separately from chronic and relapsing uveitis and controls. The consistence of prediction models is discussed in the light of supporting etiological diagnosis by machine learning processes. In conclusion, proof of principle has been obtained that the IR spectral pattern of AH may reflect particular uveal diseases.
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Affiliation(s)
- Sara Caldrer
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar di Valpolicella (Verona) 37024, Italy.
| | - Niccolò Deotto
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar di Valpolicella (Verona) 37024, Italy.
| | - Grazia Pertile
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar di Valpolicella (Verona) 37024, Italy.
| | - Giuseppe Bellisola
- INFN - Laboratori Nazionali di Frascati, Via E. Fermi, 54, Frascati (Rome) 00044, Italy.
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Wang CT, Chang YH, Tan GSW, Lee SY, Chan RVP, Wu WC, Tsai ASH. Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases. Diagnostics (Basel) 2023; 13:diagnostics13081461. [PMID: 37189561 DOI: 10.3390/diagnostics13081461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Indirect ophthalmoscopy and handheld retinal imaging are the most common and traditional modalities for the evaluation and documentation of the pediatric fundus, especially for pre-verbal children. Optical coherence tomography (OCT) allows for in vivo visualization that resembles histology, and optical coherence tomography angiography (OCTA) allows for non-invasive depth-resolved imaging of the retinal vasculature. Both OCT and OCTA were extensively used and studied in adults, but not in children. The advent of prototype handheld OCT and OCTA have allowed for detailed imaging in younger infants and even neonates in the neonatal care intensive unit with retinopathy of prematurity (ROP). In this review, we discuss the use of OCTA and OCTA in various pediatric retinal diseases, including ROP, familial exudative vitreoretinopathy (FEVR), Coats disease and other less common diseases. For example, handheld portable OCT was shown to detect subclinical macular edema and incomplete foveal development in ROP, as well as subretinal exudation and fibrosis in Coats disease. Some challenges in the pediatric age group include the lack of a normative database and the difficulty in image registration for longitudinal comparison. We believe that technological improvements in the use of OCT and OCTA will improve our understanding and care of pediatric retina patients in the future.
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Affiliation(s)
- Chung-Ting Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Yin-Hsi Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL 60612, USA
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
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Rabelo IA, Soares MC, Torigoe AMS. Profile of patients treated with intravitreal antiangiogenics in a Brazilian public service with high level of complexity. Arq Bras Oftalmol 2023; 87:e20220119. [PMID: 39298727 PMCID: PMC11623446 DOI: 10.5935/0004-2749.2022-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/15/2022] [Indexed: 09/22/2024] Open
Abstract
PURPOSE Intravitreal antiangiogenic therapy is currently the most invasive ophthalmic procedure performed worldwide. This study aimed to describe the clinical and epidemiological profile of patients undergoing intravitreal antiangiogenic therapy in a tertiary referral hospital in Brazil. METHODS This cross-sectional, retrospective, and observational study analyzed medical records of patients who received intravitreal injections of antiangiogenic agents for the treatment of retinal diseases at the ophthalmology outpatient clinic in the Hospital das Clínicas at Unicamp between January and December 2020. RESULTS The study included 429 patients and 514 eyes. The study population was predominantly male (51.28%), white (80.89%), between 50 and 80 years old (mean age, 60.92 years), had complete or incomplete first-grade education (56.88%), and did not belong to the Regional Health Department of which Campinas is a part (78.55%). Bevacizumab was the most commonly used intravitreal injectable medicine (79.38%), pro re nata was the most commonly used treatment regimen (90.27%), and macular edema was the most prevalent pathology indicative of treatment (60.12%), with diabetes etiology accounting for 48.25%. The average number of injections per patient was 3.83, with the macular neovascularization group and the pro re nata group having the highest and lowest with five and three injections, respectively. Treatment adherence was associated with the patient's pathology, and the macular edema (52.24%) and macular neovascularization (49.48%) groups had the lowest adherence rates. CONCLUSIONS This study evaluated the epidemiological and clinical profile of patients undergoing antiangiogenic therapy in a high-complexity public hospital, which is fundamental for a better understanding of the demand for ophthalmic reference service in Brazil, and the analysis of functional results and user adherence profile promotes optimization of indications and leverages the benefits of intravitreal therapy.
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Affiliation(s)
- Isadora Andrade Rabelo
- Serviço de Oftalmologia, Hospital das Clínicas,
Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marina Crespo Soares
- Serviço de Oftalmologia, Hospital das Clínicas,
Universidade Estadual de Campinas, Campinas, SP, Brazil
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Kogoleva LV, Ivanova MS, Demchenko EN, Sudovskaya TV, Bobrovskaya JA, Kokoeva NS, Makarova AA. Clinical manifestation, course and treatment results of Coats disease in children. RUSSIAN OPHTHALMOLOGICAL JOURNAL 2023. [DOI: 10.21516/2072-0076-2023-16-1-41-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Purpose: to analyze the clinical manifestations, course, and results of treatment of Coats disease in children. Materials and methods. We performed a retrospective analysis of medical records of 59 patients with Coats retinitis (83 % were boys) who had been comprehensively examined and treated between 2018 and 2021. After the diagnosis was verified, the children were hospitalized for treatment. Retinal laser coagulation was performed on 61 eyes, angiogenesis inhibitors were administered on 1 eye, and 5 eyes received microsurgical interventions. Results. At the time of disease detection, the children’s age varied from 1 to 16 years. In 97 % of cases, the process was unilateral. An improvement of the anatomical condition and the eye-preserving effect were achieved in 87 %. Visual acuity could only be increased in 19 eyes (31.1 %), all with the initial or the advanced stages of Coats retinitis. Proceeding from our experience, the analysis of polymorphism of clinical manifestations, functional prognosis and differentiated approach to treatment depending on the prevailing clinical symptoms, we suggest a new variant of clinical classification of Coats retinitis. Conclusion. In order to ensure a timely diagnosis of the disease, a very thorough examination of patients in the first decade of life is required. Only an early diagnosis and timely treatment can help achieve not only an eye-preserving effect but also functional results.
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Affiliation(s)
- L. V. Kogoleva
- Helmholtz National Medical Research Center of Eye Diseases
| | - M. S. Ivanova
- Helmholtz National Medical Research Center of Eye Diseases
| | | | | | | | - N. Sh. Kokoeva
- Helmholtz National Medical Research Center of Eye Diseases
| | - A. A. Makarova
- Helmholtz National Medical Research Center of Eye Diseases
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41
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O'Leary F, Campbell M. The blood-retina barrier in health and disease. FEBS J 2023; 290:878-891. [PMID: 34923749 DOI: 10.1111/febs.16330] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/05/2021] [Accepted: 12/17/2021] [Indexed: 12/20/2022]
Abstract
The blood-retina barrier (BRB) is the term used to define the properties of the retinal capillaries and the retinal pigment epithelium (RPE), which separate the systemic circulation from the retina. More specifically, the inner blood-retina barrier (iBRB) is used to describe the properties of the endothelial cells that line the microvasculature of the inner retina, while the outer blood-retina barrier (oBRB) refers to the properties of the RPE cells that separate the fenestrated choriocapillaris from the retina. The BRB is not a fixed structure; rather, it is dynamic, with its components making unique contributions to its function and structural integrity, and therefore the retina. For example, while tight junction (TJ) proteins between retinal endothelial cells are the key molecular structures in the maintenance of the iBRB, other cell types surrounding endothelial cells are also important. In fact, this overall structure is termed the neurovascular unit (NVU). The integrity of the BRB is crucial in the maintenance of a 'dry', tightly regulated retinal microenvironment through the regulation of transcellular and paracellular transport. Specifically, breakdown of TJs can result in oedema formation, a hallmark feature of many retinal diseases. Here, we will describe the oBRB briefly, with a more in-depth focus on the structure and function of the iBRB in health and diseased states. Finally, the contribution of the BRB to the pathophysiology of age-related macular degeneration (AMD), diabetic retinopathy (DR) and other rarer retinal diseases will be discussed.
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Affiliation(s)
- Fionn O'Leary
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Matthew Campbell
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
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42
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Coats disease in India: clinical presentation and outcome in 675 patients (690 Eyes). Int Ophthalmol 2023; 43:531-540. [PMID: 35987971 DOI: 10.1007/s10792-022-02451-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To study the clinical profile, treatment, and visual outcome of patients with Coats disease in India. METHODS This was a cross-sectional, observational hospital-based study of patients diagnosed with Coats disease during a 10-year period using an electronic medical record system. RESULTS We identified 675 patients with Coats disease with a prevalence rate of 0.025%. The mean age of the patients was 16.8 years (median, 12 years). Majority were males (75%) with unilateral presentation (98%) in first decade of life (n = 309, 46%). The most common presentation was foveal exudation (stage 2B, n = 161, 23.3%), followed by exudative retinal detachment-extrafoveal (stage 3A1, n = 143, 20.7%), and extrafoveal exudation (stage 2A, n = 136, 19.7%). Treatment modalities included observation (48 eyes, 17%), laser photocoagulation ± intravitreal bevacizumab/triamcinolone acetonide (n = 82, 29%), cryotherapy ± intravitreal bevacizumab/triamcinolone acetonide (n = 64, 23%), and surgical intervention (n = 86, 31%). Despite appropriate treatment, at mean follow-up of 16 months, there was no significant difference between presenting and final visual acuity (48% vs. 48%, p > 0.05). Using multivariate regression analysis, factors associated with poor visual outcome were younger age (< 0.001; - 0.02 to - 0.1), unilateral disease (0.04; - 0.68 to - 0.01), cataract (0.004; 0.13 to 0.69), retinal detachment (< 0.001; 0.49 to 0.82), and glaucoma (< 0.001; 0.34 to 0.94). CONCLUSION The most common clinical presentation of Coats disease in India is foveal exudation in first and second decade. At initial presentation, about half of the affected eyes had blindness and one-third underwent surgical intervention.
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Bruzzone F, Beltraminelli T, Casanova A, Menghini M. Management of Coats-Like Disease in a Forty-Four-Year-Old Patient with FSHD Type I. Case Rep Ophthalmol 2023; 14:250-256. [PMID: 37383166 PMCID: PMC10294264 DOI: 10.1159/000531007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 06/30/2023] Open
Abstract
A forty-four-year-old female patient known for FSHD type I, with unremarkable past ocular history, complained of progressive visual acuity deterioration during a routine ophthalmological visit. Best-corrected visual acuity (BCVA) was 1.0 decimal Snellen equivalent bilaterally. Dilated fundus examination showed evidence of retinal Coats-like disease in the left eye, while the right eye showed significant retinal vascular tortuosity. Multimodal examinations (OCT scans and FA-fluorescein angiography) revealed large areas of retinal ischemia, thus confirming a retinal vascular disorder compatible with the diagnosis of Coats-like disease. Left eye laser photocoagulation of the ischemic areas was performed to avoid neovascular complications that had not been detected during follow-up visits (12 months), and BCVA in the left eye remained stable at 1.0 decimals Snellen equivalent. Coats-like disease in a patient affected by FSHD type I should always be screened even in the absence of any prior ocular diseases. Guidelines concerning the ophthalmological management of adults affected by FSHD are lacking. Based on this case, we recommend performing a yearly complete ophthalmological checkup with dilated fundus examination and retinal imaging. Patients should, furthermore, be encouraged to seek medical attention when noticing deterioration of visual acuity or other visual symptoms in order to avoid missing potential sight-threatening ocular complications.
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Affiliation(s)
- Francesca Bruzzone
- Clinica di Oftalmologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Tim Beltraminelli
- Clinica di Oftalmologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Alex Casanova
- Clinica di Oftalmologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Moreno Menghini
- Clinica di Oftalmologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
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Badhwar V, Yeo DC, Joshi S, Clifton C, Fraser M, Naeem Z, Sagoo MS, Reddy MA. Changing trends in pseudoretinoblastoma diagnoses: A 10 year review from the United Kingdom. Eur J Ophthalmol 2023; 33:129-135. [PMID: 35484797 DOI: 10.1177/11206721221093190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM To study the different types and frequency of pseudoretinoblastoma (pseudoRB) lesions who present to a retinoblastoma centre due to concern that the condition may be retinoblastoma. METHODS A retrospective chart review of 341 patients presenting sporadically to the Royal London Hospital from January 2009 to December 2018. RESULTS 220 patients (65%) were confirmed to have retinoblastoma, while 121 (35%) had pseudoRB. There were 23 differential diagnoses in total. The top 3 differential diagnoses were Coats' disease (34%), Persistent Foetal Vasculature (PFV) (17%) and Combined Hamartoma of Retina and Retinal Pigment Epithelium (CHR-RPE) (13%). PseudoRBs differed with age at presentation. Under the age of 1 (n = 42), the most likely pseudoRB conditions were PFV (36%), Coats' disease (17%) and CHR-RPE (12%). These conditions were also the most common simulating conditions between the ages of 1 and 2 (n = 21), but Coats' disease was the most common in this age group (52%), followed by CHR-RPE (19%) and PFV (14%). Between the ages of 2 and 5 (n = 32), Coats' disease remained the most common (44%) pseudoRB lesion followed by CHR-RPE (13%), or PFV, Retinal Astrocytic Hamartoma (RAH), familial exudative vitreoretinopathy (FEVR) (all 6.3%). Over the age of 5 (n = 26), pseudoRBs were most likely to be Coats' disease (35%), RAH (12%), Uveitis, CHR-RPE, FEVR (all 7.7%). CONCLUSION 35% of suspected retinoblastoma cases are pseudoRB conditions. Overall, Coats' disease is the most common pseudoRB condition, followed by PFV. Hamartomas (CHR-RPE & RAH) are more prevalent in this cohort, reflecting improvements in diagnostic accuracy from referring ophthalmologists.
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Affiliation(s)
- Vinay Badhwar
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK.,6084Northampton General Hospital NHS Trust, Northampton, UK
| | - Damien Cm Yeo
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK.,Department of Ophthalmology, Alder Hey Children's Hospital, 4593Alder Hey NHS Foundation Trust, Liverpool, UK
| | - Samruddhi Joshi
- 105711Barts and the London School of Medicine and Dentistry, UK
| | - Charlotte Clifton
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK
| | - Maxine Fraser
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK
| | - Zishan Naeem
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK
| | - Mandeep S Sagoo
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, City Road, London, UK
| | - M Ashwin Reddy
- Retinoblastoma Service, Royal London Hospital, 9744Barts Health NHS Trust, London, UK
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Tondelli NN, Mencaroni BM, Lemos CMB, Rocha de Sousa J, Sandoval Barbosa GC, Gomes AMV, da Palma MM. A patient with X-linked retinoschisis and exudative retinal detachment associated with a pathogenic hemizygous variant c.304c>T in RS1. Ophthalmic Genet 2022; 43:871-875. [PMID: 36695495 DOI: 10.1080/13816810.2022.2154809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND X-linked retinoschisis (XLRS) is a rare retinal dystrophy due to pathogenic variants in the RS1 gene. The hallmark of the disease is a foveal spoke-wheel appearance. The purpose of this report is to expand the phenotypic spectrum of XLRS reporting a patient with atypical phenotype of XLRS associated with Coats-like phenotype. MATERIALS AND METHODS This is a case report of a patient diagnosed with XLRS who underwent ophthalmologic multimodal imaging and next-generation sequencing panel. RESULTS The proband is a 14-year-old male patient who presented at Instituto Suel Abujamra with a history of Coats Disease in the right eye treated with retinal laser in both eyes two years ago. His best-corrected visual acuity was count finger at 1 foot in the right eye and 20/40 in the left eye. Fundus exam showed an extensive area of exudation and retinal detachment in the right eye and cystic change at the fovea in a spoke-wheel pattern in the left eye. The next-generation sequencing panel targeting inherited retinal diseases with 236 genes found a pathogenic hemizygous variant c.304C>T (p.Arg102Trp) in RS1 that has already been reported. CONCLUSIONS The association of peripheral vascular incompetence and XLRS has already been described. Retinal exudation in the setting of XLRS is probably the result of vascular disruption and compromise. The loss of retinoschisin function that leads to foveal retinoschisis may also lead to vascular anomalies.
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Affiliation(s)
| | | | | | | | | | | | - Mariana Matioli da Palma
- Instituto Suel Abujamra, São Paulo, Brazil.,Department of Ophthalmology, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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Coats plus syndrome with new observation of drusenoid retinal pigment epithelial detachments in a teenager. Am J Ophthalmol Case Rep 2022; 28:101713. [PMID: 36177296 PMCID: PMC9513731 DOI: 10.1016/j.ajoc.2022.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
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Clinicopathological Correlations in Enucleated Globes of Late-Stage Coats Disease with a Review of the Literature. J Epidemiol Glob Health 2022; 12:496-503. [PMID: 36175755 DOI: 10.1007/s44197-022-00068-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Coats disease may cause diagnostic dilemma because of its variable clinical presentation that can be suspicious of retinoblastoma. Late sequelae of the disease are blinding with possible enucleation. We demonstrate the main histopathological findings of Coats enucleated eyes with literature review. METHODS This was a retrospective study of all enucleated globes diagnosed as Coats disease over 30 years and were reviewed by two pathologists. The corresponding demographic data, clinical presentation, pre-operative clinical impression, and indication for enucleation were collected. Descriptive analysis of our own series data was performed. Our findings were then correlated to published data that were collected from 1983 to 2021 from the PUBMED database in English-written language. Shields classification was used as an inclusion criterion for the published reports to be analyzed. RESULTS We had seven enucleated globes with Coats disease. Mean age at presentation was 3.2 years (range 3 months to 9 years). Male predominance was observed in 6 and all cases were unilateral. Strabismus was the most common initial presentation (57%, n = 4), followed by leukocoria (43%, n = 3). Indication for enucleation was mostly suspected retinoblastoma (57%, n = 4). Four eyes were classified as stage 4, and 2 had advanced stage 5 changes. Histopathologically, subretinal fluid with lipid-laden macrophages was seen in all cases, the anterior chamber was shallow in 5/7 with angle neovascularization in 2/7. Telangiectatic vessels were clearly observed in 4/7. CONCLUSION Coats disease is a potentially visually disabling disease that is mostly unilateral in 95%, has male predominance of 81%, and wide age range with a mean of 17 years. In Saudi Arabia, the disease seems to present at younger age, tends to be more advanced, and may be indistinguishable from retinoblastoma at the time of diagnosis. Shields staging of Coats is highly recommended to be followed clinically to unify the pathways for treatment and to correlate the concluded outcomes.
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48
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Gad M, Sen M, Shields CL. Dramatic Fluorescein Angiography in a Child. J Pediatr Ophthalmol Strabismus 2022; 59:209. [PMID: 35856430 DOI: 10.3928/01913913-20220420-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Bats ML, Peghaire C, Delobel V, Dufourcq P, Couffinhal T, Duplàa C. Wnt/frizzled Signaling in Endothelium: A Major Player in Blood-Retinal- and Blood-Brain-Barrier Integrity. Cold Spring Harb Perspect Med 2022; 12:a041219. [PMID: 35074794 PMCID: PMC9121893 DOI: 10.1101/cshperspect.a041219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Wnt/frizzled signaling pathway is one of the major regulators of endothelial biology, controlling key cellular activities. Many secreted Wnt ligands have been identified and can initiate diverse signaling via binding to a complex set of Frizzled (Fzd) transmembrane receptors and coreceptors. Roughly, Wnt signaling is subdivided into two pathways: the canonical Wnt/β-catenin signaling pathway whose main downstream effector is the transcriptional coactivator β-catenin, and the noncanonical Wnt signaling pathway, which is subdivided into the Wnt/Ca2+ pathway and the planar cell polarity pathway. Here, we will focus on its cross talk with other angiogenic pathways and on its role in blood-retinal- and blood-brain-barrier formation and its maintenance in a differentiated state. We will unravel how retinal vascular pathologies and neurovascular degenerative diseases result from disruption of the Wnt pathway related to vascular instability, and highlight current research into therapeutic options.
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Affiliation(s)
- Marie-Lise Bats
- Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
- Department of Biochemistry, Pellegrin Hospital, University Hospital of Bordeaux, 33076 Bordeaux Cedex, France
| | - Claire Peghaire
- Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Valentin Delobel
- Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Pascale Dufourcq
- Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Thierry Couffinhal
- Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
- Centre d'exploration, de prévention et de traitement de l'athérosclérose (CEPTA), CHU Bordeaux, 33000 Bordeaux, France
| | - Cécile Duplàa
- Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
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Joseph AK, Guerin JB, Eckel LJ, Dalvin LA, Keating GF, Liebo GB, Benson JC, Brinjikji W, Laack NN, Silvera VM. Imaging Findings of Pediatric Orbital Masses and Tumor Mimics. Radiographics 2022; 42:880-897. [PMID: 35245105 DOI: 10.1148/rg.210116] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.
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Affiliation(s)
- Annie K Joseph
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Julie B Guerin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J Eckel
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lauren A Dalvin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gesina F Keating
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Greta B Liebo
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John C Benson
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Waleed Brinjikji
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Nadia N Laack
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - V Michelle Silvera
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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