Coats disease: An overview of classification, management and outcomes

Abstract

Coats disease is an idiopathic retinal vascular disorder with retinal telangiectasia with intraretinal and/or subretinal exudation without appreciable retinal or vitreal traction. The condition is sporadic with no associated systemic abnormalities. Unilateral involvement in young males is the typical presentation with most cases being diagnosed in the first and second decade of life. Younger the patient, more severe is the presentation and poorer the visual outcome. The management varies with the stage of the disease. Over the years, we have shifted from enucleation to a more conservative approach for the treatment of Coats disease with laser photocoagulation, cryotherapy and surgery for retinal detachment achieving good outcomes. The anti-VEGF agents have come into the scene as important form of adjuvant treatment along with the traditional management options. This article describes the clinical features, underlying pathology, classification and staging, the complications and the management of Coats disease and gives an overview of the changing trends in treatment and outcomes spanning across five decades.

Microincision vitrectomy for secondary epiretinal membrane in adult-onset Coats’ disease

“…Diagnosis of Coats' disease should not be accepted in an adult until other causes of exudative retinopathy are clearly excluded. 1 Although ERM in Coats' disease (both juvenile and adult-onset) is a rare entity, it might cause significant visual acuity loss in these patients. 1 Its exact pathogenesis is not known, but it develops secondary to excessive retinal photocoagulation or cryoretinopexy.…”

“…1 Although ERM in Coats' disease (both juvenile and adult-onset) is a rare entity, it might cause significant visual acuity loss in these patients. 1 Its exact pathogenesis is not known, but it develops secondary to excessive retinal photocoagulation or cryoretinopexy. 7 Shields et al in their study of 150 patients with juvenile and adult-onset Coats' disease found ERM in 2.5 % of treated eyes with poor visual outcomes [1], while Rishi et al reported a higher incidence of ERM (4.4%).…”

“…1 Its exact pathogenesis is not known, but it develops secondary to excessive retinal photocoagulation or cryoretinopexy. 7 Shields et al in their study of 150 patients with juvenile and adult-onset Coats' disease found ERM in 2.5 % of treated eyes with poor visual outcomes [1], while Rishi et al reported a higher incidence of ERM (4.4%). 3 Our case had no history of any ocular treatment.…”

“…Clinical manifestations include idiopathic retinal telangiectasia with intraretinal and/or subretinal exudation without appreciable retinal or vitreal traction. 1 It can result in serious complications including neovascular glaucoma, amblyopia, and anterior segment abnormalities such as anterior chamber cholesterolosis, cataract, persistent subfoveal fluid or exudates eventually leading to macular fibrosis. Adult-onset Coats' disease has less extensive involvement, hemorrhage near larger vascular dilatations, more benign natural course, and a more favorable treatment outcome as against the childhood-onset disease.…”

Tumoren und Pseudotumoren der Netzhaut und des Ziliarepithels

“…3). Häufig liegen auch subretinale Exsudationen, Makulaödeme und Blutungen vor [14]. Dies resultiert in einer erheblichen Visusbeeinträchtigung und, da der Erkrankungsbeginn früh ist, in einer tiefen Amblyopie.…”