Coats' Disease
Background
- Described by Georges Coats (Scotland) in 1908
- Unilateral retinal vascular abnormalities and retinal exudation in young males
- Similar to Leber's descripiton of a similar condition in 1912 called Leber's disease
Clinical Features
- Idiopathic retinal telangiectasia
- Intraretinal and/or subretinal exudation leading to retinal detachment
- Peripheral retinal nonperfusion
- Vitreous relatively normal
- Sporadic
- No systemic abnormalities
- Unilateral (if bilateral second eye is very mildly affected)
- Male in first or second decade of life
- Xanthocoria
Differential Diagnosis
- Retinal tumors
- hemangioblastoma
- retinoblastoma
- choroidal hemangioma
- Exudative vitreoretinopathies
- Retinopathy of Prematuity
- Familial Exudative Vitreoretinopathy
- Norrie disease
- Other causes of leukocoria
- retinal hemorrhage
- toxocariasis
- persistent fetal vasculature
- coloboma
- endophthalmitis
- CMV retinitis
- toxoplasmosis
Classification
Stage | Fundus Features | |
---|---|---|
1 | Retinal telangiectasia only | |
2 | Telangiectasia and Exudation | |
A | Extrafoveal exudation | |
B | Foveal exudation | |
3 | Exudative Retinal Detachment | |
A | Subtotal detachment | |
A1 | Extrafoveal | |
A2 | Foveal | |
B | Total retinal detachment | |
4 | Total retinal detachment and glacuoma | |
5 | Advanced end-stage disease (phthisis with pain) |
Laser Treatment
- Diode 532nm recommended by Shapiro et al.
- Power generally 400 to 750 mW
- Duration 1000 ms
- Rapid interval cycles to simulate near continuous treatment
- endpoint: telangiectatic vessel whitening
- Diode 810nm recommended by Villegas et al.
- Large (1.2 mm) spot size
- Power typically around 350 mW
- treat entire surface of telangiectatic vessels and/or exudative detachment as well as the avascular retina.
- endpoint: complete whitening of the telangiectatic vessels
- add bevacizumab 1.25 mg
Anti-VEGF Treatment
- adjunctive treatment
- 1.25 mg via pars plana