Vitrectomy for a secondary epiretinal membrane following treatment of adult-onset Coats’ disease

Abstract

Purpose To report a case of adult-onset Coats’ disease that had worsening of macular edema and progressive macular traction following cryotherapy and repeated intravitreal bevacizumab injections due to formation of a secondary epiretinal membrane which only improved following pars plana vitrectomy and membrane peeling. Observations A 35-year-old male presented with diminution of vision in his left eye and was found to have localized telangiectatic retinal vessels and aneurysmal dilatations with massive exudation and cystoid macular edema. He was diagnosed as adult-onset Coats’ disease and treated with cryotherapy and a concomitant intravitreal injection of 2.5 mg bevacizumab followed by 3 monthly intravitreal injections of 2.5 mg bevacizumab and a single injection of 4 mg triamcinolone acetonide. Partial obliteration of the telangiectatic vessels and aneurysmal dilatations with improvement in surrounding lipid and fluid exudate was achieved, however, this was associated with progressive worsening of macular edema and macular traction due to formation of an epiretinal membrane which only improved following vitrectomy and membrane peeling. Effect of therapy at each stage was evaluated using visual acuity testing, fundus examination, fundus fluorescein angiography, and optical coherence tomography. Conclusion and Importance A secondary epiretinal membrane can develop following treatment of adult-onset Coats’ disease and cause traction especially when combining cryotherapy with bevacizumab injections. Vitrectomy in such cases with membrane peeling may result in improvement of anatomical and functional outcomes.

Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review

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“…is occurs due to release of various inflammatory cytokines and growth factors, most importantly vascular endothelial growth factor (VEGF), following chronic hyperglycemia [6]. Several treatment modalities are available for DME, including the intravitreal injection of anti-VEGF drugs such as off-label intravitreal bevacizumab injections, which are also used in the treatment of macular edema associated with various other retinal conditions [7][8][9][10][11]. Because the therapeutic effect of these drugs is only temporary, however, long-term treatment is often required which raises concerns for worsening of macular ischemia and visual function due to chronic suppression of VEGF that could result in increased capillary dropout and inhibition of reperfusion of occluded capillaries [12,13].…”

Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema

“…In fact, it is the commonest cause of vision loss in diabetics and affects an estimated 21 million people worldwide [ 5 ]. Treatment of macular edema due to various retinal conditions, including DME, currently depends on the repeated intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents [ 6 - 9 ]. This may be due to the fact that VEGF is central to the pathogenesis of many of these retinal conditions including DR and DME [ 10 ].…”