First Author: A.Matsou GREECE
Co Author(s): C. Symeonidis D. Tzetzi P. Riga P. Brazitikos
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Coats' disease is an idiopathic, typically unilateral, condition characterized by abnormal telangiectasia, aneurysms, exudation and eventually exudative retinal detachment. It has been described in early childhood with the adult-onset variety being much more rare and management strategies may differ to the paediatric population. We aim to present a case of adult onset Coats' disease managed with a combination of anti-VEGF and intravitreal dexamethasone implant.
2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece.
A 43-year-old female presented with sudden reduction of vision on her left eye (OS), floaters, flashes and a nasal field defect. There was no previous ocular or medical history of note. Examination of the right was unremarkable. Best corrected visual acuity of OS was 1/10. Fundus examination of OS revealed vitreous haze, telangiectasia of the temporal retina with haemorrhages, marked retinal and subretinal exudation and an exudative retinal detachment (ERD) extending to the fovea. Clinical findings combined with fluorescein angiography confirmed a diagnosis of Coats' disease Stage 3A (Shields classification, Proctor lecture 2000). Initial approach included two ranibizumab injections at monthly intervals with only slight anatomical and clinical improvement (BCVA 2/10 1 month after second injection). We then proceeded with the injection of intravitreal dexamethasone implant (Ozurdex). 2 months following the implant injection the ERD was eased and BCVA improved to 4/10.
Following 2 ranibizumab injections and a dexamethasone implant we achieved anatomical stabilization and improvement, avoiding so far the permanent retinal damage and pro-inflammatory effect of cryotherapy or laser photocoagulation.
Combination therapeutic strategies for adult-onset Coats' disease have been recently attempted, usually a sequence of cryotherapy or Argon-laser photocoagulation and anti-VEGF agents (bevacizumab/ranibizumab) and vice versa. Intravitreal dexamethasone implants have lately been added on the armamentarium of treatment options for Coats' disease, reducing the number of anti-VEGF injections required and perhaps averting the employment of the traditionally used techniques of cryotherapy and laser photocoagulation. Long term effects are yet to be reviewed.