Optical Coherence Tomography Angiography Findings After Intravitreal Ranibizumab in Patients With Coats Disease

Abstract

The aim of this retrospective study was to describe the vascular features in eyes with Coats disease, using optical coherence tomography angiography (OCTA), at baseline and after 3 monthly intravitreal injections of ranibizumab. Fifteen eyes of 15 consecutive patients affected by Coats' disease were recruited in this study. All patients underwent the best-corrected visual acuity (BCVA) evaluation, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), multicolor imaging, structural Spectral Domain (SD)-OCT and OCTA at baseline and 1 month after the third monthly ranibizumab injection (loading phase). Fifteen patients completed the study, of whom nine were males and six females. Mean age was 20.4 ± 2 years. BCVA was 0.46 ± 0.11 logMar and 0.47 ± 0.12 logMar at baseline and after treatment, respectively (p = 0.164). SD-OCT revealed no significant decrease in central macular thickness (486.33 μm ± 93.37 at baseline vs. 483.4 μm ± 80.97 after treatment; p = 0.915). The subretinal exudates persisted in macular region after intravitreal injections. OCTA showed a general vascular rarefaction in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillary (CC) that did not change after loading phase. This study showed no functional and vascular improvement following 3 monthly ranibizumab injections. OCTA, non-invasive technique, could be useful during follow up of these patients and provide a better understand of pathogenesis of this disorder.

Optical coherence tomography angiography and multimodal imaging in the management of coats’ disease

“…In agreement with the findings of Cennamo et al and Hautz et al, the retinal vascular flow patterns were not convincingly different following anti-VEGF treatment. 6 , 9 However, the choroidal vascular density appeared increased following anti-VEGF therapy, according to the selected slabs. As OCTA studies have shown that anti-VEGF agents result in decreased choroidal density, presumably due to pharmacological vasoconstriction, 10 the relative improvement in choroidal slabs on our OCTA figures may be the results of artifact or may imply a possible role of choroidal vasculature in pathology of Coats' disease patients.…”

Clinical features and treatment outcomes of a patient with retinitis pigmentosa secondary to adult coats' disease

“…The gold standard test for diagnosis is FA. Besides, OCT can identify macular edema and exudates 19 . This patient was consistent with stage 2B Coats disease according to Shields' Classi cation 20 .…”

Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases

“…This may be due to the vascular supply of the SCP and DCP, with the DCP being distal vessels with weaker walls and more likely to be disrupted in Coats disease [ 84 ]. In another series by Cennamo et al, the authors noted capillary hypoperfusion with an increased FAZ area in the SCP, along with irregularly dilated small perifoveal vessels and a loss of collateral branches and increased vascular rarefaction, were noted in the DCP [ 85 ]. In eyes with macular fibrosis, a disrupted vascular network and coarse macula vessels may be observed using OCTA [ 82 ].…”

“…In eyes with macular fibrosis, a disrupted vascular network and coarse macula vessels may be observed using OCTA [ 82 ]. However, it is important to note that subretinal exudate may lead to obscuration of choriocapillaris (CC), and manual segmentation of OCTA images in a patient with macula exudates may be required to accurately visualize blood vessels [ 84 , 85 ]. In addition, OCTA of Coats disease may also reveal an irregular FAZ with crossing vessels on both the SCP and DCP [ 10 ].…”

“…In addition, OCTA of Coats disease may also reveal an irregular FAZ with crossing vessels on both the SCP and DCP [ 10 ]. A study performed by Cennamo et al regarding treatment response monitoring using OCT and OCTA after serial intravitreal anti-VEGF in Coats disease in 15 eyes in 15 patients with a mean age of 20.4 ± 2 years also showed subretinal exudates persisted in the macular region and generalized vascular rarefaction was still noted in the SCP, DCP and CC [ 85 ]. Overall, by identifying subtle changes using OCT and OCTA, which guided the treatment strategy and monitoring of the treatment effect, the above study showed potential for the application of these novel imaging modalities in Coats disease [ 78 ].…”