First Author: A.López Gaona SPAIN
Co Author(s): N. Pastora Salvador J. Garcia Martinez J. Peralta Calvo R. Montejano Milner A. Jimenez Gonzalez
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To describe clinical characteristics and anatomical and functional results of the treatment of paediatric (under 16 years old) Coats' disease in a tertiary hospital
Retrospective study at a single institution (Department of Ophthalmology, La Paz Hospital)
Retrospective case series including patients treated during the period 2000-2016. Demographic, clinical and treatment-related data are collected. The characteristics of maculopathy and the therapeutic response are studied by OCT and OCT-Angiography (OCT-A).
29 patients (29 eyes) were included. The mean age at diagnosis was 4.70 years (5 months-14 years). 27 patients (93.1%) presented a stage superior to 2A at diagnosis, and 4 stage 4 (13.7%). (83% cryotherapy, 59% laser) and 18 (62%) with antiangiogenic adjuvants. The mean number of treatments for cryotherapy, laser and antiangiogenic was 1.75, 1.64 and 2.6 respectively. Four patients underwent vitreoretinal surgery and two required neurolysis (stage 4). One patient required enucleation for suspected retinoblastoma. The final visual acuity ≥20 / 200 in 14 eyes (48%). Final visual acuity was significantly worse in patients who presented macular involvement (p = 0.01). It was possible to obtain macular OCT in 17 patients and OCT-A in 13. Of 12 cases with subfoveal nodule, it was possible to perform OCT-A in 9 of them detecting: retinal-retinal anastomosis in 8 (89%), vascular element entering in the nodule in 8 (89%) and subretinal neovascularization in 3 (33%) of them.
Current treatment modalities for paediatric Coats' disease present a high rate of anatomical preservation and visual improvement. The lower age at diagnosis, macular involvement and the presence of total retinal detachment are correlated with a worse visual prognosis. OCT-A may demonstrate abnormal macular vascularization (retinal-retinal anastomosis and subretinal neovascularization) in patients with subfoveal nodule which may occur secondary, in the course of the disease, and probably related to chronic accumulation of subfoveal exudates. As far as we know, this is the first description using OCT-A of macular vascular alterations in subfoveal nodule.