Subfoveal nodule in Coats disease: Towards an updated classification predicting visual prognosis

Session Details

Session Title: Free Paper Session 11: Vascular Diseases & Diabetic Retinopathy III

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 12:06

Venue: Room 114

First Author: : A.Daruich SWITZERLAND

Co Author(s): :    A. Moulin   H. Tran   A. Matet   F. Munier                    

Abstract Details

Purpose:

To determine the prevalence, clinical characteristics and nature of subfoveal nodules in Coats disease and the associated impact on the long-term visual outcome.

Setting:

Retrospective case-control study

Methods:

Consecutive cases of Coats disease with foveal exudation were reviewed. The presence of a subfoveal nodule or macular fibrosis was recorded. Clinical characteristics, retinal imaging and outcome were analyzed by comparative analysis. The histopathological description of an enucleated eye with subfoveal nodule was performed.

Results:

Among 40 patients presenting unilateral stage 2B or 3A1 Coats disease, a subfoveal nodule was detected in 21 patients (52.5%). The median follow-up was 4.7 years. Nineteen patients (47.5%) did not present a subfoveal nodule. Three patients (15.8%) without subfoveal nodule and 21 patients (100%) with subfoveal nodule progressed to a macular fibrotic scar (p<0.0001), and the mean time of macular fibrosis onset was 11.0 ± 2.6 months. Final visual acuity was significantly worse in patients who presented a subfoveal nodule at diagnosis (p=0.01). Of 18 cases with subfoveal nodule who underwent fluorescein angiography, retinal-retinal anastomosis and neovascularization were detected in 13 (72.2%) and 2 eyes (11.1%), respectively. Histopathological analysis of a subfoveal nodule revealed an aggregate of proteinaceous material including fibrin, spindle cells, macrophages and pigmented cells.

Conclusions:

The presence of a subfoveal nodule at presentation is a predictive factor for macular fibrosis development and worse visual outcome in patients with Coats disease. These observations suggest an updated classification introducing two subcategories within Stage 2B: Without subfoveal nodule (Stage 2B1) and with subfoveal nodule (Stage 2B2).

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