Juvenile Coats disease successfully managed with green diode laser using indirect ophthalmoscope

Abstract

Objective To study the effects and outcomes of green diode laser therapy under indirect ophthalmoscope in the treatment of juvenile Coats disease.Methods Nineteen juvenile Coats disease patients (19 eyes) well enrolled in this study.Average age at presentation was 73.5 months (27-146 months).Best corrected visual acuity (BCVA) was ≥0.1 in 7 eyes; 0.01 to 0.09 in 8 eyes; counting finger in 3 eyes and light perception in 1 eye.The macular of all eyes was involved.There were 3 eyes with macular exudative retinal detachment,4 eyes with sub-macular fibrosis,1 eye with macular atrophy.Exudative area was more than two quadrants in 17 eyes,and less than two quadrants in 2 eyes.The abnormal blood vessels located in the superior or nasal-superior retina (2 eyes) or inferior or temple-inferior area (17 eyes).Exudative retinal detachment occurred in 13 eyes,in which macular was not involved in 10 eyes,and macular was involved in 3 eyes.All patients were treated with green diode laser (532 nm) ablation therapy under general anesthesia and indirect ophthalmoscope to areas of the retina telangiectasia.3 patients received a single intravitreal 2 mg triamcinolone injection (IVTA).Average follow-up was 18.5 months (6-51 months).Main outcome measures included visual acuity,retinal vascular abnormalities,subretinal exudates and exudative retinal detachment.Results Among 3 patients treated with IVTA,one needed cataract extraction and one needed pre-retinal membrane peeling surgery.After laser photocoagulation,resolution of telangiectasia lesions was achieved in all patients at the end of follow up.Exudation was resolved in 8 eyes,reduced in 9 patients and no change in 2 eyes.Exudative detachment was resolved in 8/13 eyes,reduced in area in 3/13 eyes and no change in 2 eyes.There were 9 eyes with sub-macular fibrosis and 3 eyes with macular atrophy at the end of follow-up.The visual acuity was stable in most cases.BCVA was ≥0.1 in 6 eyes; 0.01 to 0.09 in 11 eyes; counting finger in 1 eyes and light perception in 1 eye.Compared to the normal eyes,eyes with Coats disease tended to be more hyperopic (t=3.6,P =0.003) and astigmatic (t=3.6,P=0.004),but no correction were needed for these refractive errors.Conclusions Green diode laser therapy under indirect ophthalmoscope can be an effective treatment for juvenile Coats disease with little complications.IVTA can be helpful,but must be used with cautions as it can induce some complications. Key words: Retinal telangiectasis/therapy; Laser coagulation; Ophthalmoscopy/utilization