Coats disease: fluorescein angiography guided management

Abstract

AbstractPurpose To study the anatomical and visual outcome of patients (pts) with Coats disease treated with laser or cryotherapy on the basis of fluorescein angiography (FA) findings.Methods 28 children, mean age at diagnosis 6 ys, have been included. They all underwent examination under anaesthesia, fluorescein angiography (FA) with RetCam and laser treatment or cryotherapy. Changes in best corrected visual acuity (VA) pre and post treatment were recorded. Retinal imaging was repeated when possible.Results 6 pts were classified as Stage 2a, 17 as Stage 2b, 4 as stage 3Ai, one as Stage 3b. In the 25 patients who had FA, 15 had telangectatic vessels for less than 6 clock hours, mainly in the temporal periphery, and in 10 they involved more than 6 clock hours. FA showed areas of capillary bed closure starting from the area of the telangectasia up to 360 degree in the retinal periphery. 21 patients were treated with laser photocoagulation, 2 with cryotherapy and 4 with cryotherapy and laser to the telangectatic vessels and peripheral ischaemic areas. After treatment, 22 pts showed reduced exudation or no change, 6 pts had an increase in exudation and required further laser or cryo therapy. 9 pts with stage 2b showed improvement or stabilization of VA, in 4 VA deteriorated. All pts with stage 2a maintained good VA.Conclusion FA provides useful information about the distribution of telangectasia and of ischaemic areas in Coats disease. Laser treatment to the telangectatic vessels and ischaemic area is effective in improving the anatomical outcome and preserve vision. FA is helpful in guiding treatment and reduces the number of treatments necessary.