Abstract
BackgroundThe exact pathogenetic mechanisms of Coats’ disease remain unknown. In this report, we show two cases of Coats’ disease that achieved a favorable prognosis with the combined treatment of intravitreal bevacizumab (IVB) injection prior to photocoagulation, although both initially resisted photocoagulation therapy.Case presentationsCase 1 was a 15-year-old boy with initial visual acuity of 0.4 OD. At the temporal retina, aneurysms and abnormal telangiectatic vessels were observed. Hard exudates and an exudative retinal detachment extended to the fovea. He was diagnosed as having Coats’ disease at stage 3A and we performed laser photocoagulation as an initial approach to treat peripheral aneurysms and telangiectatic vessels. After the treatment, the exudative retinal detachment was eased and visual acuity improved to 1.0; however, recurrence occurred after 5 months. The exudative change was resistant against laser photocoagulation therapy and we therefore added IVB as an adjuvant before photocoagulation. Fourteen days after IVB injection phased laser photocoagulation was given to cover the abnormal capillaries, aneurysms and the leakage area spotted in FA. A good prognosis was obtained with decreased exudation and improved visual acuity.Case 2 was an 11-year-old boy with decreased visual acuity of 0.15 OS at the initial visit. Hard exudates, retinal edema and serous retinal detachment were seen at the macula and peripheral retina. Fluorescein angiography revealed telangiectatic capillaries at the temporal retina. Our diagnosis was Coats’ disease at stage 3A. Extensive photocoagulation was performed as an initial treatment to the lesion. However, the exudative change was severe and resistant against the photocoagulation treatment. Therefore, we added IVB as an adjuvant before photocoagulation. Exudative change in the retina seemed to be eased 7 days after IVB injection, therefore, phased laser phototherapy was added to cover the abnormal capillaries. After the combination therapy, exudative change was remarkably ameliorated and better visual acuity was achieved.ConclusionBevacizumab is considered an effective adjuvant for Coats’ disease with exudative change resistant to retinal photocoagulation therapy.
Highlights
The exact pathogenetic mechanisms of Coats’ disease remain unknown
Laser photocoagulation is not very effective for cases with severe exudative changes and, the prognosis depends on the presence or absence of exudative retinal detachment
Cases that have severe exudative changes in the retina are often resistant to laser therapy and progress to an advanced level of subretinal exudation or fibrosis, which necessitates cryotherapy with surgical drainage of sub-retinal fluid (SRF) or pars plana vitrectomy [3]
Summary
IVB injection can be an effective method of treatment for Coats’ disease that is resistant to photocoagulation therapy alone. Authors’ contributions AK carried out substantial part of the work by diagnosing the patients, treating and following up them, analyzing the acquired data and made a draft manuscript to finalize it upon suggestions and advice from the other authors. KS participated in the treatment by carrying out IVB injection and laser photocoagulation in the patients and contributed in revising the manuscript critically for important intellectual content. All authors read and approved the final manuscript. Author details 1Department of Ophthalmology, Kinki University Faculty of Medicine, 377-2, Ohnohigashi, Osaka-Sayama City, Osaka 589-8511, Japan. Author details 1Department of Ophthalmology, Kinki University Faculty of Medicine, 377-2, Ohnohigashi, Osaka-Sayama City, Osaka 589-8511, Japan. 2Department of Ophthalmology, Sakai Hospital Kinki University Faculty of Medicine, 2-7-1, Harayamadai, Minami Ward, Sakai City, Osaka 590-0132, Japan
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