Longitudinal Examination of Fellow-Eye Vascular Anomalies in Coats' Disease With Widefield Fluorescein Angiography: A Multicenter Study

Abstract

BACKGROUND AND OBJECTIVE: Retinovascular anomalies in the fellow eyes of patients with Coats’ disease have been described, but the clinical significance is unknown, as well as whether these lesions progress over time. PATIENTS AND METHODS: This is an international, multi center, retrospective, observational cohort study of fellow-eye abnormalities on widefield fluorescein angiography in patients with Coats’ disease. RESULTS: Three hundred fifty eyes of 175 patients with Coats’ disease were analyzed. A total of 33 patients (18.8%) demonstrated abnormal fellow-eye findings: 14 (42.4%) telangiectasias, 18 (54.5%) aneurysms, six (18.2%) segmental non-perfusion, six (18.2%) leakage, and two (6.0%) vascular tortuosity. All eyes were asymptomatic, and none of the lesions progressed over time. There was no association between fellow-eye findings with severity of Coats’ disease (P = .16), patient age (P = .16), or presence of systemic vascular disease (P = .16). CONCLUSIONS: The vascular abnormalities in fellow eyes of patients with Coats’ disease did not progress over time. Observation is a reasonable initial management strategy.

Optical Coherence Tomography Angiography in Pediatric Retinal Disorders

“…12,13 In addition, an indistinct FAZ with anomalous transverse vessels and vascular congestion in the parafovea has been observed in unaffected fellow eyes. 12,14-16 These findings are consistent with the hypothesis that more cases of Coats disease might be bilateral than previously thought, although they are highly asymmetric in nature. This asymmetry is clearest in marked decreased vascular density in the SCP and DCP in eyes with Coats disease compared with that in fellow eyes.…”

Evidence Against a Contralateral Coats Phenotype by Optical Coherence Tomography Angiography

“… 3 Approximately 18% of fellow eyes of patients with Coats disease may show asymptomatic, nonprogressive vascular abnormalities. 4 Importantly, such peripheral changes could also be observed in heathy eyes, complicating the interpretation of these findings. 5 The study of macular changes in Coats disease determined by optical coherence tomography angiography (OCTA) has yielded inconclusive results concerning the laterality of Coats disease.…”

Coats disease in female population: A comparison of clinical presentation and outcomes

“…Despite being usually a unilateral disease, 11 patients (6.9%) had bilateral involvement in our study. The rate of bilateral involvement showed a lot of discrepancies in literature ( 4 – 6 , 8 , 11 – 14 ). Some of these studies were based solely on fundus photographs ( 4 ), while others used FA imaging ( 6 ).…”

“…Some of these studies were based solely on fundus photographs ( 4 ), while others used FA imaging ( 6 ). The use of FA and more recently wide-field imaging systems helped detect more peripheral abnormalities ( 11 – 13 ). The improvement in detection of peripheral vascular anomalies using wide-field imaging systems may improve the detection and the classification of Coats disease, as it has already been demonstrated in other vascular pathologies such as diabetes ( 15 ).…”

“…Brockmann et al ( 14 ) reported on the presence of vascular changes on ultra wide-field FA in all the fellow eyes (100%) of middle-aged patients (mean age of 33.2 years and range between 12 and 66 years) with Coats disease and concluded that Coats disease seems to be an asymmetric bilateral disease, with abnormalities predominant in one eye. Vascular abnormalities consisted of peripheral non-perfusion, leakage, vascular tortuosity and occlusion or dilatation of capillaries ( 11 , 12 , 16 – 18 ). Among the 11 patients with bilateral involvement in our study, 6 had a normal contralateral fundus and abnormalities were only seen on FA.…”