Treatment of Coats’ disease: an analysis of pooled results
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Aparna Ramasubramanian. Department of Ophthalmology & Visual Sciences, University of Louisville, 301 E Muhammad Ali Boulevard, Louisville, KY 40202, USA. Aparna.ramasubramanian@louisville.edu

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Unrestricted institutional grant from Research to Prevent Blindness.

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    Abstract:

    AIM: To elucidate the association of treatment modality to vitreoretinal fibrosis and traction retinal detachment (TRD) in Coats’ disease. METHODS: A PubMed search for Coats’ disease with included studies describing eyes with clinical features and treatment course of Coats’ disease. Binary logistic regression with fibrosis at presentation and treatment type as independent variables was performed to determine predictors of TRD historically (since 1921) and in the anti-vascular endothelial growth factor (VEGF) era (since 2007). Odds ratios (OR) with 95% confidence intervals (CI) reported. RESULTS: Of 175 articles described 1183 eyes. Vitreoretinal fibrosis increased from presentation (5.4%) to follow-up (15.5%) and TRD increased from 0.44% to 3.9% at follow up. Laser was protective against vitreoretinal fibrosis (OR 0.6, 95%CI 0.4-0.9) but TRD was borderline (OR 0.6, 95%CI 0.3-1.1). Cryotherapy showed a higher association with TRD (OR 1.9, 95%CI 1.0-3.7) than with vitreoretinal fibrosis (OR 0.8, 95%CI 0.5-1.2). Similarly, intravitreal anti-VEGF alone was not associated with fibrosis (OR 1.1, 95%CI 0.6-1.8) nor TRD (OR 1.1, 95%CI 0.5-2.6) but the combination of laser and anti-VEGF therapy was protective [Fibrosis: 0.1 (0.03, 0.35); TRD: 0.05 (0.01, 0.23)] compared to anti-VEGF plus cryotherapy (P<0.001). Disease stage ≤2B or ≥3A was not associated with TRD. CONCLUSION: Vitreoretinal fibrosis and TRD increase after treatment in Coats’ disease. The combination of anti-VEGF agents and cryotherapy may lead to higher risk for TRD. Presence of pre-treatment fibrosis is the highest risk factor for post-treatment worsening of vitreoretinal fibrosis and TRD.

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Janelle Fassbender Adeniran, Sarah M Duff, Michael Mimouni, et al. Treatment of Coats’ disease: an analysis of pooled results. Int J Ophthalmol, 2019,12(4):668-674

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Publication History
  • Received:September 23,2018
  • Revised:October 18,2018
  • Adopted:
  • Online: March 06,2019
  • Published: