Intraoperative Fluorescein Angiography–Guided Treatment in Children with Early Coats' Disease

doi:10.1016/j.ophtha.2015.02.002

Ophthalmology

Volume 122, Issue 6, June 2015, Pages 1195-1202

https://doi.org/10.1016/j.ophtha.2015.02.002 Get rights and content

Purpose

To review the anatomic and visual outcomes of a series of children diagnosed with Coats' disease and treated on the basis of intraoperative fluorescein angiography (FA) findings.

Design

Retrospective case series.

Participants

Twenty-five children 2 to 15 years of age diagnosed with early Coats' disease and treated after intraoperative FA.

Methods

Retrospective review of patients who underwent treatment for stage 2 Coats' disease in a tertiary center in the United Kingdom between 2007 and 2012. The children underwent treatment to the telangiectatic vessels and associated areas of retinal nonperfusion identified on intraoperative FA performed with a wide-angle retinal camera (RetCam II).

Main Outcome Measures

Anatomic and structural assessment of the retina after treatment, visual acuity (VA), and complications related to treatment.

Results

Twenty children with Coats' disease who underwent intraoperative RetCam FA and retinal ablative treatment and who had more than 3 months of follow-up were identified from clinical records. All had unilateral disease. Six eyes were classified as stage 2a, and 14 eyes were classified as stage 2b. The median duration of follow-up was 21 months (mean, 26 months). Fifteen eyes needed 1 treatment to stabilize the disease, and 5 eyes needed a second treatment. None of the patients demonstrated progression of the disease to a more severe stage. Twelve eyes had a final VA of 0.4 logarithm of the minimum angle of resolution (logMAR) or better, 6 patients had VA between 0.4 and 1.0 logMAR, and 2 patients had VA worse than 1.0 logMAR.

Conclusions

The treatment of retinal telangiectasia and areas of retinal nonperfusion identified by wide-angle intraoperative FA in children with stage 2 Coats' disease led to good anatomic outcome, with preservation of VA in most cases.

Section snippets

Patients

We identified 25 children with a diagnosis of Coats' disease who attended the pediatric retinal service at Moorfields Eye Hospital from December 2007 through March 2012 and underwent treatment for stage 2 Coats' disease after intraoperative FA using the RetCam II. This study has been approved by the Hospital Review Board and was performed in accordance with the Declaration of Helsinki. To be included in the study, the patients had to show idiopathic telangiectasia and lipid exudation in the

Results

Twenty-five patients who had undergone intraoperative FA before treatment of Coats' disease were identified. Twenty had at least 3 months of follow-up after treatment and were included in the study. Table 2 shows demographic characteristics, age at presentation, and first clinical symptoms.

Discussion

The purpose of this study was to investigate whether treatment of children with stage 2 Coats' disease based on the extent of retinovascular changes identified on portable wide-angle FA would result in fewer treatment sessions and an improved outcome. The advantage of intraoperative FA is that the full extent of the retinovascular abnormalities can be identified and treated in comparison with historical treatment, in which treatment is administered to those areas of abnormality identified on

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Cataract development in children with Coats disease: risk factors and outcome
2018, Journal of AAPOS
To describe the clinical features of cataract during the course of Coats disease and to determine its risk factors and effects on the long-term visual outcome.
The medical records of consecutive patients with Coats disease followed for at least 2 years were analyzed retrospectively. Ophthalmological examination, ancillary tests, and treatment modalities were reviewed. The time of cataract diagnosis and its management were recorded. Parameters influencing cataract development and final visual outcome were investigated using uni- and multivariate analysis.
A total of 57 patients (mean age, 5.0 ± 4.0 years; 51 males) were included; cataract formation was observed in 16 (28%) during a mean follow-up of 7.1 ± 3.7 years. The mean time from diagnosis of Coats disease to cataract detection was 25 ± 22 months. Total white cataract developed in 12 patients (75%); posterior subcapsular cataract, in 4 (25%). Cataracts were surgically removed in 10 patients to improve fundus visualization and clinical follow-up. Presence of exudative retinal detachment at diagnosis was an independent risk factor for cataract formation (P = 0.031). Cataract development was associated with more advanced disease stages (P < 0.001). History of cataract was a significant predictor for worse final visual outcome (P < 0.001), independent of disease stage (P = 0.003) and presence of macular complication, such as atrophy, fibrosis, or tractional retinal detachment (P < 0.001, adjusted R² = 0.83).
Cataract development is frequent in children with Coats disease and aggravates the visual prognosis. Exudative retinal detachment at diagnosis, present in more advanced disease stages, is an independent risk factor for cataract formation.
Comparison of Visual Outcomes in Coats’ Disease: A 20-Year Experience
2017, Ophthalmology
To report differences in visual acuities among patients with Coats' disease who sought treatment at a tertiary care university-based practice.
Single-center retrospective cohort study.
Patients with Coats' disease diagnosed clinically, angiographically, or both from 1995 through 2015.
Patients were divided into 2 groups based on date of presentation: decade 1 (1995–2005) and decade 2 (2006–2015).
Visual acuity (VA).
Thirty-nine eyes of 39 patients were included with 19 eyes presenting in decade 1 and 20 eyes presenting in decade 2. Three patients demonstrated bilateral disease, but only the worse eye was included for analysis. Forty-seven percent of eyes in decade 1 demonstrated advanced stages of disease (stage 3B or worse) compared with 20% of eyes in decade 2. There was a trend for the mean initial presenting VA (±standard deviation) for decade 1 eyes to be worse (2.05±1.29 logarithm of the minimum angle of resolution [logMAR]) than for decade 2 eyes (1.45±0.99 logMAR; P = 0.1). From initial to final follow-up visit, mean VA also worsened for decade 1 eyes (P = 0.03), but remained stable for decade 2 eyes (P = 1.0). At the end of follow-up, there was a trend for mean VA for decade 1 eyes (2.28±1.17 logMAR) to be worse than for decade 2 eyes (1.60±1.15 logMAR; P = 0.07). Eight eyes were observed initially in decade 1 compared with 1 eye in decade 2, and only 1 of the observed eyes (in decade 2) developed painful glaucoma requiring enucleation. Decade 2 eyes had a higher average number of procedures per eye (6.5±4.9) compared with decade 1 eyes (1.4±1.7; P < 0.001).
The earlier presentation of disease in decade 2 suggests improvements in disease detection over time. Furthermore, there was a trend for eyes to have better final VA in this decade. This is due to a combination of factors, including earlier presentation of disease, fewer eyes being observed without treatment, and eyes, when treated, receiving a higher number of procedures.
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: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Support for this study was from the National Institute of Health Research UK (Moorfields Eye Hospital BRC).

: Author Contributions

: Conception and design: Suzani, Moore

: Analysis and interpretation: Suzani, Moore

: Data collection: Suzani

: Obtained funding: Moore

: Overall responsibility: Suzani, Moore

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Original articleIntraoperative Fluorescein Angiography–Guided Treatment in Children with Early Coats' Disease

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Patients

Results

Discussion

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

J AAPOS

Ophthalmology

J AAPOS

J AAPOS

Differentiation of Coats’ disease and retinoblastoma

J Pediatr Ophthalmol Strabismus

A population-based study of Coats’ disease in the United Kingdom I: epidemiology and clinical features at diagnosis

Eye (Lond)

Coats’ disease. Natural history and results of treatment

Am J Ophthalmol

Management of moderate to advanced Coats’ disease

Ophthalmologica

Effects of green diode laser in the treatment of pediatric Coats’ disease

Am J Ophthalmol

Coat’s disease: clinical, angiographic, histopathological findings and clinical management

Br J Ophthalmol

Advanced Coats’ disease. management with repetitive aggressive laser ablation therapy

Retina

Fluorescein angiography with RetCam in incontinentia pigmenti: a case report

Arch Soc Esp Oftalmol

Original article
Intraoperative Fluorescein Angiography–Guided Treatment in Children with Early Coats' Disease