Coats Disease in a 14-year-Old Boy Treated with Intravitreal Ranibizumab and Retinal Laser Photocoagulation

Introduction

Coats disease was first described in 1908, by George Coats [1]. Since then, numerous articles have been published on its clinical features and variations, pathology, possible pathogenesis, differential diagnosis, and treatment. It is a sporadic non-hereditary disease not associated with any identifiable systemic abnormalities [2]. In order to avoid confusion and according to a study published in 2001 by Shields et al., Coats disease was defined as an idiopathic congenital retinal telangiectasia accompanied by intraretinal and/or subretinal exudation without appreciable vitreoretinal traction [3].

Other clinical features of this entity are young age at the time of presentation (mean age at diagnosis, 10 years), male predilection (≥ 75 % of cases occurring in males), and unilateral affection (approximately 95 % of the patients have unilateral disease) [1] [2] [3]. Although the differential diagnosis of Coats disease includes many ocular diseases, it must primarily be differentiated from retinoblastoma [2]. When the main clinical and demographic features of the disease are not met, diagnosis is questionable.

In the early stages of Coats disease, treatment mainly aims at obliterating the telangiectasias using laser photocoagulation and/or cryotherapy [2] [3]. In advanced cases, surgical intervention combined with photocoagulation or cryotherapy may be required [2] [3]. A painful eye due to secondary glaucoma in end stages often requires enucleation [2] [3].

Recent research of the pathogenetic mechanisms of the disease suggests a possible role of vascular endothelial growth factor (VEGF) [2] [4]. Additionally, published case series support the beneficial role of anti-VEGF therapy as an adjuvant therapy in Coats disease [4].

We report a case of Coats disease in a 14-year-old male patient that was treated with intravitreal administration of ranibizumab and laser photocoagulation.

• References

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• 3 Shields JA, Shields CL, Honavar SG et al. Classification and management of Coats disease: the 2000 Proctor Lecture. Am J Ophthalmol 2001; 131: 572-583
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