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Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction
  1. Aparna Ramasubramanian,
  2. Carol L Shields
  1. Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Carol L Shields, Ocular Oncology Service, Suite 1440, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA; carol.shields{at}shieldsoncology.com

Abstract

Aim To evaluate the effect of supplemental intravitreal bevacizumab for management of Coats' disease.

Methods Retrospective analysis of eight patients with Coats' disease manifesting total or partial exudative retinal detachment where the retinal telangiectasia was treated with standard laser photocoagulation and/or cryotherapy plus additional intravitreal bevacizumab (1.25 mg/0.05 ml).

Results The mean patient age was 88 (range 7–240) months and 63% were male. Coats' disease was classified as stage 2 (n=1, 12%), 3a (n=3, 38%) and 3b (n=4, 50%). Features included retinal detachment (n=8, 100% with mean detachment extent involving 8 clock hours), telangiectasia (n=8, 100% with mean extent of 8 clock hours), peripheral retinal ischaemia on fluorescein angiography (n=7, 88%) and no evidence of neovascularisation. Treatment consisted of cryotherapy (n=8, 100%), laser photocoagulation (n=4, 50%) and bevacizumab intravitreal injection (n=8) with median number of one injection per eye (mean 1.75, and range 1–4 injections). After a mean follow-up of 8.5 months, resolution of retinopathy (n=8, 100%), Coats'-related subretinal fluid (n=8, 100%) and retinal exudation (n=6, 75%) was noted. However, vitreous fibrosis developed (n=4, 50%) at a mean of 5 months following a mean of 1.75 bevacizumab injections with three (38%) evolving into traction retinal detachment.

Conclusion Coats' disease treated with intravitreal bevacizumab in addition to standard therapy can develop to vitreoretinal fibrosis and potentially traction retinal detachment. These tractional features are not often found in Coats' disease treated with standard measures without bevacizumab. Caution is advised in the use of bevacizumab for patients with Coats' disease.

  • Coats' disease
  • bevacizumab
  • vascular endothelial growth factor (VEGF)
  • telangiectasia
  • fibrosis
  • traction retinal detachment

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Footnotes

  • AR had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding Support provided by the Retina Research Foundation of the Retina Society in Cape Town, South Africa (CLS), and the Eye Tumour Research Foundation, Philadelphia, Pennsylvania, USA (CLS). The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review or approval of the manuscript.

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Wills Eye Institute IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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