Lifting the White Walker’s curse–Management of Coats’ disease

Background: Coats’ disease, described by George Coats in the early 1900s, is an idiopathic unilateral retinal vascular abnormality with exudation occurring in young males. It is characterized by retinal telangiectasia with intraretinal or subretinal exudation. Coats’ disease is mostly diagnosed in the first to the second decade of life, with a common presentation of leukocoria. Younger patients have a more severe presentation and are associated with poor visual prognosis. Management of Coats’ disease varies from observation, cryotherapy with anti?VEGFs (Vascular Endothelial Growth Factor), and surgery to enucleation. The mode of treatment depends on the age of presentation, the severity of the disease, and the stage of the disease. Through this video, we describe the clinical features, pathology, and surgical management of a 2?year?old child with grade 3B of Coats’ disease. Purpose: To demonstrate successful surgical management of grade 3B of Coats’ disease in a 2?year?old boy. Synopsis: Coats’ disease mostly presents with a diagnostic dilemma due to its varied presentation. Early detection and treatment are the keys to salvaging the eye as well as the vision, hence, avoiding dreadful complications such as neovascular glaucoma or phthisis bulbi. We demonstrate successful surgical management of a child who presented with grade 3B of Coats’ disease. Highlights: Through this video, we aim to describe the clinical features, pathology, and surgical management of a 2?year?old child with grade 3B of Coats’ disease. Combination of external drainage with vitrectomy, challenges faced, and the importance of visual rehabilitation postoperatively

Long-term outcomes of adjuvant intravitreal injection of conbercept therapy in juvenile Coats disease / 中华眼底病杂志

Objective:To study the long-term effects and outcomes of adjuvant intravitreal injection of conbercept (IVC) therapy in juvenile Coats disease.Methods:A retrospective case series study. From January 1, 2015 to December 31, 2018, 40 patients (40 eyes) who were diagnosed as juvenile Coats disease at Beijing Tongren Hospital Affiliated to Capital Medical University were included in the study. Among them, there were 37 males (37 eyes) and 3 females (3 eyes). All patients had unilateral Coats disease. The average age was 55.00 (44.75, 81.25) months. Five eyes were in stage 2B, 15 eyes were in stage 3A, 19 eyes were in stage 3B and 1 eye was in stage 4. Idiopathic retinal vascular telangiectasia associated with extensive subretinal fluid (SRF) (stage 3 or above) or massive foveal exudation and edema (stage 2B) were found in fundus examination. All affected eyes underwent wide-field color fundus images and fluorescein fundus angiography. Thirty-one eyes underwent best corrected visual acuity (BCVA) examination. The BCVA was carried out using a standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity. All cases received adjuvant IVC combined with treatments such as retinal photocoagulation. The average number of injections was 4 (1, 5). The average follow-up after initial treatment was 59.00 (52.50, 63.00) months. The changes in BCVA, occlusion of abnormal blood vessels in fundus, absorption of SRF and ocular and systemic complications were observed.Results:At last follow-up, among 31 affected eyes with the examination of BCVA, 13 (32.5%, 13/40) eyes had an improved vision, 12 eyes(30.0%, 12/40) had a stable vision and 6 eyes (15.0%, 6/40) had a decreased vision. The difference between average logMAR BCVA of the affected eyes in each stage after treatment and that before treatment was not statistically significant ( Z=-0.56, -1.80, -0.84; P>0.05). Abnormal blood vessels in fundus were all partially or completely occluded, and SRF was obviously or completely absorbed in all cases; of which, 28 eyes (70.0%, 28/40) were completely occluded, and 12 eyes (30.0%, 12/40) were partially occluded. No patient underwent eye enucleation. Nineteen eyes (47.5%, 19/40) developed vitreoretinal fibrosis; 8 eyes (20.0%, 8/40) developed tractional retinal detachment; 15 eyes (37.5%, 15/40) developed complicated cataract. None had ocular or systemic complications related to IVC therapy during follow-up. Conclusions:IVC combined with classic treatments such as photocoagulation in juvenile Coats disease can keep or improve the visual acuity in most juvenile patients by reducing SRF. IVC is a long-term safe and effective adjuvant therapy in juvenile Coats disease.

Pediatric Coats disease of stage 2 and greater managed with 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab / 中华眼底病杂志

Objective:To investigate the efficacy of 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab (IVR) in treating stage 2 and greater pediatric Coats disease.Methods:A retrospective, non-controlled clinical study. From February 2018 to August 2020, 21 eyes of 21 patients with Coats disease stage 2 and greater diagnosed by examination in the Eye Center of Beijing Tongren Hospital were included in the study. Among them, 20 patients were males; 1 patient was female. Mean age was 5.00±1.92 years old. Stage 2A, 2B, 3A, 3B, and 4 were 2, 8, 7, 2, and 2 eyes, respectively. All eyes underwent wide-field fundus color photography and fluorescein fundus angiography (FFA). Best corrected visual acuity (BCVA) was performed in 17 eyes. Abnormal dilated retinal blood vessels, interretinal and subretinal exudates were found in all eyes. Abnormally dilated capillaries and aneurysms in the retina was shown in FFA examination. All eyes underwent 532 nm laser photocoagulation using indirect ophthalmoscope combined with IVR. Patients with severe retinal detachment of stage 3B or greater were treated by external drainage of subretinal fluid (SRF). The subsequent treatment was the same as before. The follow-up time was 35.67±6.13 months. Relevant examinations were performed using the same equipment and methods before. The frequency of treatment, visual acuity changes, anatomic prognosis, and complications were observed.Results:The frequency of eye photocoagulation was 2.43±0.98. The number of IVR treatments was 2.00±0.89. Three eyes were treated with SRF drainage in the first time. At the last follow-up, visual acuity improved, no change, and decreased in 5, 11, and 1 eyes after BCVA examination, respectively. In 21 eyes, the retina was in situ in 17 eyes; 5 eyes with retinal cysts. During the follow-up, cataract and vitreous hyperplasia occurred in 1 eye, which was treated by vitrectomy, and mild vitreous hyperplasia occurred in 1 eye.Conclusion:Indirect ophthalmoscope 532 nm wavelength laser combined with IVR is an effective treatment for pediatric Coats disease.

Retinopatía del prematuro con presentación atípica / Retinopathy of prematurity with atypical presentation

La retinopatía de la prematuridad es una enfermedad dinámica vasoproliferativa de la retina inmadura postnatal que afecta a los bebés prematuros. Cuando aparecen signos de atipicidad en su diagnóstico o evolución deben descartarse otras entidades vasculares de la retina, que generalmente tienen un trasfondo genético y semejan o coexisten con dicha entidad. Se presenta un caso con características de Retinopatía del prematuro y algunos signos de atipicidad. Se describe su manejo y evolución, así como una breve descripción de las entidades que conforman el diagnóstico diferencial(AU)

Retinopathy of prematurity is a dynamic vasoproliferative disease of the immature postnatal retina that affects premature babies. When signs of atypicality appear in its diagnosis or evolution, other vascular entities of the retina must be ruled out, which generally have a genetic background and resemble or coexist with said entity. We present a case with characteristics of Retinopathy of prematurity and some signs of atypicality. Its management and evolution are described, as well as a brief description of the entities that make up the differential diagnosis(AU)

Coats’ disease – Prognostic factors for globe and vision salvage in children, a long-term experience

Coats’ disease is associated with poor outcomes, and there are limited studies on long?term outcomes of Coats’ disease. The purpose of our study is to identify various predictive factors to help in prognosticating the treatment outcomes in advanced Coats’ disease in children. Methods: This is a retrospective case series from a single tertiary eye care center of children (<18 years) diagnosed with coat’s disease. Sixty?seven patients with Coat’s disease were identified from the medical records from 2009 to 2020. Patients’ demographic data, clinical presentation, stage, extent of involvement, detailed treatment history, clinical sequelae post?treatment (including complications and anatomical and functional outcomes) were noted. Binary logistic regression was performed to correlate the predictive factors for anatomical and functional improvement. Results: Of the 67 patients, 51 eyes of 51 patients were included in the study. The male to female proportion was 2.2. Mean age at presentation was 4.98 ± 3.55 years (range: 2 months–15 years). Mean duration of follow?up was 31.53 ± 26.38 months. Overall, our globe salvage rate was 92.2%. We found that vitreoretinal fibrosis (P < 0.001), subretinal gliosis (P < 0.001), vitreous hemorrhage (P = 0.02), tractional or combined retinal detachment (P < 0.001), foveal scar (P < 0.006), and cataract (P < 0.001) to be important factors to affect the outcome. Conclusion: Advanced stage of presentation (stage 3B and above), diffuse involvement, cataract, vitreoretinal fibrosis (preretinal and subretinal), vitreous hemorrhage, tractional or combined retinal detachment, and anterior hyaloid proliferation are poor prognostic factors for globe salvage in advanced disease. Subretinal gliotic nodule or scar and lack of visual rehabilitation suggest poor functional outcomes

Anti-VEGF therapy in pediatric retinal and choroidal disease / 国际眼科杂志(Guoji Yanke Zazhi)

@#Vascular endothelial growth factor(VEGF)is a key factor of the angiogenesis during embryonic period, and it is also an important mediator of the pathological neovascularization and vascular permeability in various ophthalmic diseases. With the increasing use of anti-VEGF therapy in adults, more and more clinical studies are focused on the application of anti VEGF therapy in pediatric retinal and choroidal diseases, including retinopathy of prematurity, Coats disease, familial exudative vitreoretinopathy, incontinence pigmented related retinopathy, sickle cell retinopathy, retinoblastoma and choroidal neovascularization caused by various causes. In this article, the application of anti VEGF therapy in these pediatric retinal and choroidal diseases was reviewed.

Progress in the pathogenesis and treatment of Coats disease / 国际眼科杂志(Guoji Yanke Zazhi)

@#Coats disease is characterized by abnormal dilation of retinal capillaries and exudation of the inner and outer layers of the eye retina. It can be mostly seen in male teenagers. So far, there have no clear etiology and pathological mechanism. The common treatment methods of Coats disease, which are the laser photocoagulation, cryotherapy, drug therapy, combination therapy(anti VEGF drugs combined with laser), surgical treatment(simple vitrectomy and or scleral drainage)and traditional Chinese medicine and other emerging treatment methods. The traditional Chinese medicine and Western medicine on the etiology and pathogenesis of the disease and the treatment of traditional Chinese and Western medicine were systematically reviewed in this paper.

Enfermedad de coats / Coats disease

RESUMEN Introducción: La enfermedad de Coats es una vasculopatía retiniana idiopática, poco frecuente, que puede progresar a desprendimiento de retina exudativo y glaucoma neovascular. Típicamente se presenta en la infancia, es la tercera causa más frecuente de leucocoria infantil. Presentación de caso: Paciente masculino de dos años de edad, procedente de zona rural. Asiste a consulta, porque la mama notó que el niño desvía el ojo derecho hacia fuera desde que nació. Conclusiones: La enfermedad de Coats simula otras vasculopatías retinianas y el retinoblastoma. La conducta a seguir dependerá de la, forma clínica de presentación y complicaciones asociadas.

ABSTRACT Introduction: Coats disease is a rare, idiopathic retinal vasculopathy that can progress to exudative retinal detachment and neovascular glaucoma. Typically occurring in childhood, it is the third most common cause of childhood leukocoria. Case report: Patient masculine of two years of age, coming from rural area. You attended consultation, because he/she suckles her he/she noticed that the boy deviates the right eye toward it was since he was born. Conclusions: Coats disease simulates other retinal vasculopathies and retinoblastoma. The behavior to be followed will depend on the clinical form of presentation and associated complications.

Coats disease in 351 eyes: Analysis of features and outcomes over 45 years (by decade) at a single center

Purpose: To assess features and outcomes of Coats disease over 5-decades. Methods: Retrospective review of Coats disease patients at a single center. Features and outcomes were compared based on decade of presentation. Results: There were 351 patients with Coats disease. The presenting median age (6 years), male sex (84%), and unilaterality (100%) did not change per decade. Coats disease classification did not change per decade with Stage 1 (1%), Stage 2 (21%), Stage 3 (68%), Stage 4 (6%), and Stage 5 (1%). Clinical features that changed per decade (1970s vs. 1980s vs. 1990s vs. 2000s vs. 2010s) included 1980s features of more eyes with exudation in all 4 quadrants (22% vs. 58% vs. 44% vs. 33% vs. 27, P = 0.01) and total exudative retinal detachment (33% vs. 53% vs. 39% vs. 27% vs. 21%, P < 0.001). Imaging features that changed per decade included 2010s greater fluorescein angiographic extent of retinal non-perfusion in mean clock hours (4 vs. 4 vs. 3 vs. 5 vs. 6, P = 0.003), and 1980s greater mean height of retinal detachment ultrasonographically (5 vs. 12 vs. 5 vs. 5 vs. 4 mm, P < 0.001). Treatment features that changed per decade included 1980s greater primary enucleation (11% vs. 16% vs. 3% vs. 4% vs. 1%, P = 0.001), and 2010s greater use of laser photocoagulation (55% vs. 33% vs. 38% vs. 40% vs. 72%, P < 0.001), sub-Tenon corticosteroid (0% vs. 4% vs. 5% vs. 8% vs. 29%, P < 0.001), and intravitreal anti-VEGF) (0% vs. 4% vs. 2% vs. 13% vs. 18%, P = 0.003). Outcomes that changed per decade included 2010s findings of more complete resolution of subretinal fluid (64% vs. 59% vs. 38% vs. 58% vs. 72%, P = 0.01) and less need for primary/secondary enucleation (17% vs. 27% vs. 14% vs. 13% vs. 6%, P = 0.04). Conclusion: Eyes with Coats disease in the 1980s demonstrated more advanced findings, often requiring enucleation. Over the decades, greater use of laser photocoagulation and injections has led to improved disease resolution with greater globe salvage.

Coats disease: An overview of classification, management and outcomes

Coats disease is an idiopathic retinal vascular disorder with retinal telangiectasia with intraretinal and/or subretinal exudation without appreciable retinal or vitreal traction. The condition is sporadic with no associated systemic abnormalities. Unilateral involvement in young males is the typical presentation with most cases being diagnosed in the first and second decade of life. Younger the patient, more severe is the presentation and poorer the visual outcome. The management varies with the stage of the disease. Over the years, we have shifted from enucleation to a more conservative approach for the treatment of Coats disease with laser photocoagulation, cryotherapy and surgery for retinal detachment achieving good outcomes. The anti-VEGF agents have come into the scene as important form of adjuvant treatment along with the traditional management options. This article describes the clinical features, underlying pathology, classification and staging, the complications and the management of Coats disease and gives an overview of the changing trends in treatment and outcomes spanning across five decades.

A case of Leber's miliary aneurysms with diffuse peripheral retinal vascular sheathing

A 30-year-old female presented with macular edema and discoid exudation at the posterior pole. Diffuse vascular sheathing was observed at the peripheral retina. Fluorescein angiography revealed multiple microaneurysms at the posterior pole and leakage from the peripheral vessels. Two monthly intravitreal bevacizumab led to minimal improvement, and resolution of macular edema was achieved by an additional intravitreal triamcinolone. The findings at the posterior pole resembled those of Leber's miliary aneurysm. However, this case also demonstrated a peculiar vascular sheathing at the periphery and showed response to triamcinolone, which are evidences for an inflammatory condition.

Coats' disease - disease of the eye rarely encountered by pathologists

Coats' Disease is an idiopathic condition of the eye affecting young children although it can be seen in adults. Most patients present early in life with unilateral decreased vision, strabismus or leukocoria. The most important differential diagnosis is unilateral retinoblastoma. In this study we report a case of coat's disease in an young girl, and evaluate histopathological and clinical findings.

Recent advances in diagnosis and treatment of Coats disease / 眼科新进展

Coats disease,known as the outer exudative retinopathy,is a kind of disease characterized by retinal capillaries expansion and microvascular abnormalities,often accompanied by retinal or subretinal exudation and lipids exudative retinal detachment.Neovascular glaucoma and ocular atrophy often occur in the late time.Coats disease is significant diversity in clinical presentation and morphology.For nearly a century,with the development of understanding of the disease,vireoretinal specialists have a new view on diagnosis and treatment of it.This article reviews the recent progress in the diagnosis and treatment of Coats disease.

Subretinal fluid drainage combined with intravitreal injection of anti-vascular endothelial growth factor in treatment of severe exudative retinal detachment Coats disease / 眼科新进展

Objective To investigate the effects of subretinal fluid drainage combined with intravitreal anti-vascular endothelial growth factor (VEGF) drugs in the treatment of severe exudative retinal detachment Coats disease.Methods Thirteen patients (13 eyes) with 3B Coats' disease diagnosed at the Eye Center of Tongren Hospital were included in the study.The participants were aged from 1 year to 11 years with a mean age of (4.15 ± 2.99) years.The visual acuity was no light perception in 1 case,from light perception to counting finger in 7 cases,from 0.01 to 0.1 in 2 cases,and could not be measured due to young in 3 cases.Patients underwent retinal fluid drainage combined with intravitreal ranibizumab (IVR,0.5 mg,0.05 mL) at the pars plana of ciliary body,and with retinal laser photocoagulation or cryotherapy according to the retinal peripheral vascular activity.During the follow-up,the visual acuity,intraocular pressure,slit lamp,indirect ophthalmoscope and color ophthalmoscope were examined and observed.The abnormal blood vessel change,absorption of subretinal fluid,retinal reattachment and complication were observed.Results Two subretinal fluid drainage were performed in 3 cases,one subretinal fluid drainage in 10 cases.Six cases were combined with two intravitreal injections,4 cases with three intravitral injection,3 cases with intravitreal injection for more than three times.Five cases were treated with simple photocoagulation,3 cases with simple retinal cryotherapy,and 5 cases with laser combined with cryotherapy.In 13 patients,the visual acuity was improved in 2 cases,unchanged in 8 cases,and could not be measured due to young in 3 cases.Eight cases had complete retinal reattachment.No significant postoperative complications occurred during follow-up,such as endophthalmitis,retinal hole and vitreous hemorrhage.Conclusion Subretinal fluid drainage combined with intravitreal injection is an effective method for severe 3B stage Coats disease.

Efficacy of intravitreal injection of anti-VEGF drugs combination with other methods for Coats disease / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the effect of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs combined with other methods in the treatment of Coats disease.METHODS:Selected 13 patients 13 eyes with Coats disease in our hospital from May 2013 to May 2016.All eyes were treated with intravitreal injection of ranibizumab and combined with scleral drainage, laser photocoagulation and so on.We observed visual acuity and retinal reattachment.RESULTS:In 13 eyes, the treatment of 4 eyes with intravitreal injection of ranibizumab and combined with scleral drainage, 3 eyes combined laser photocoagulation, 6 eyes combined vitrectomy, membrane peeling, freezing, silicone oil filling or other treatments.Eyeball retention rate was 100%.Visual acuity at 6mo after treatment significantly improved compared with before treatment (P<0.05).The visual acuity was ≥0.05-0.1, 0.01-<0.05, counting finger, light perception and hand moving before treatment in 0, 0, 38%, 38% and 23%, after treatment were 23%, 23%, 38%, 15% and 0.Complete retinal reattachment was achieved in 5 eyes, accounting for 38%;basic reset in 3 eyes, accounting for 23%;5 eyes were not reset, accounting for 38%.CONCLUSION:Intravitreal injection of anti-VEGF drugs combined with other methods for the treatment of Coats disease have a certain effect, can improve or maintain the limited visual function, avoid enucleation of eyeball due to disease progression.

Clinical analysis of intravitreal injection of Conbercept combined with 532-laser treating Coats disease in adulthood / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze clinical observation and the efficiency of intravitreal conbercept combined with 532-laser on Coats disease in adulthood.METHODS: This was an retrospective analysis.Six eyes from 6 patients(5 males and 1 female) with coats disease diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled.Before the injection, best-corrected visual acuity (BCVA) of early treatment of diabetic retinopathy study (ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, FFA, and OCT were examined.The initial average visual acuity (ETDRS letters) were 51.17±15.15.The initial average central retina thickness (CRT) was 303.30±107.87μm.All affected eyes were treated with intravitreal conbercept 0.05mL (10mg/mL) combined with 532-laser.Patients were followed up for 6 to 12mo, with a mean duration of 7.33±1.26mo.Post-treatment BCVA were compared with baseline using repeat analysis.RESULTS: The mean BCVA showed significant improvement during 1 wk, 1, 3mo post-treatment and the latest follow up (P<0.01).During the latest follow up, the mean BCVA was obviously improved in 3 eyes (50%), improved in 2 eyes (40%), stable in 1 eyes (10%).Likewise, the subretina fluid absorption of different levels.No adverse events such as secondary retinal detachment or endophthalmitis were found during the follow-up.CONCLUSION: Coats disease in adulthood more likely to have lower symptom and have a better response on treatment.Intravitreal conbercept combined with 532-laser significantly improve visual acuity and absorb the subretina fluid.

Intravitreal lucentis injections combined with laser photocoagulation for Coats disease / 眼科新进展

Objective To observe the therapeutic effect of intravitreal lucentis injections combined with laser photocoagulation for Coats disease.Methods This was a retrospective case series study.From August 2012 to December 2015,18 cases (18 eyes) were diagnosed as Coats disease with macular edema by FFA and OCT.All patients were treated at baseline using intravitreal lucentis injections.One week later,photocoagulation was performed by the guiding of FFA.Follow-up treatment was performed as necessary.The primary BCVA and central macular thickness (CMT) was measured postoperatively.The follow-up time was 16-24 months (mean 18.8 months).Results The mean number of lucentis injections was 2.6,and the mean number of laser treatment sessions was 1.8.The mean preoperative BCVA was (0.81 ±0.28) LogMAR,while the final visit was (0.76 ± 0.37) LogMAR (P =0.396).In 3 patients (16.7 ％),BCVA had improved by more than 3 lines,and 13 patients (72.2％)showed stable BCVA (changes within 2 lines of visual acuity),while in 2 patients,BCVA decreased by more than 3 lines (11.1％).The mean CMT improved significantly from (341.11 ±67.97) μm preoperatively to (277.83 ±51.59) μm at the fmal visit (P =0.030).Final BCVA was significantly correlated with preoperative BCVA (r =0.817,P ＜0.001).The final BCVA of patients with subfoveal hard exudates preoperatively was significantly worse than that of patients without such exudates (P =0.044).Conclusion Intravitreal lucentis injection combined with laser photocoagulation may be an effective treatment for Coats disease.It may stablize the visual acuity,decrease the CMT of Coats disease.The final BCVA is associated with preoperative BCVA and occurrence of subfoveal hard exudates.

Intravitreal Ranibizumab Injection in Adult-onset Coats' Disease: A Case Report

PURPOSE: To report a case of adult-onset Coats' disease which showed decreased retinal edema and improved visual acuity following intravitreal ranibizumab injection. CASE SUMMARY: A 21-year-old woman visited our hospital for decreased visual acuity in left eye from 3 months ago. Her best corrected visual acuity was 1.0 in the right eye, and 0.4 in the left eye. The intraocular pressure was 19 mmHg in the right eye and 16 mmHg in the left eye. At anterior segment examination, no abnormal findings were found. On fundus examination, subretinal exudates, superior retinal edema at posterior pole, and telangiectasia along superortemporal vascular arcade were observed in the left eye. Upon diagnosis as Coats' disease, intravitreal ranibizumab was performed, and laser photocoagulation was done around the retinal telangiectasia and nonperfusion area. Then, the second and third intravitreal ranibizumab injections were performed by a month, and her best visual acuity was improved to 0.8 and optical coherence tomography revealed decreased retinal edema. CONCLUSIONS: We report a case of adult-onset Coats' disease. Intravitreal ranibizumab injection is effective in rapid visual improvement and decrease of retinal edema as combination therapy with laser photocoagulation which was a generalized treatment of choice in Coats' disease.

Coats’ disease of adult‑onset in 48 eyes.

Background: Coats’ disease diagnosed in adulthood is an idiopathic, retinal exudative vascular disease without an inciting factor and has retinal features different from the childhood disease. Aim: To describe clinical features, treatment, and outcomes of eyes with Coats’ disease first diagnosed in patients 35 years or older. Materials and Methods: Retrospective chart review of patients first diagnosed with Coats’ disease at the age of 35 years or more at a tertiary eye care center between January 1995 and 2012. Eyes with retinal exudation or Coats’‑like response from secondary causes were excluded. Results: Forty‑five of 646 patients (7%) diagnosed with Coats’ disease had adult‑onset disease. Mean age at presentation was 47 years. Systemic hypertension was the most common (22%) systemic association and decreased vision the predominant presenting feature (83%). Localized (<6 clock h) presentation (74%) was unique to adults as against diffuse involvement (69%) in children (P < 0.001). Eyes were treated with laser photocoagulation 29 (60%), cryotherapy (4%), or both (2%) with surgical intervention in three (6%) eyes. Following treatment eight (35%) eyes improved, 11 (48%) eyes were stable while four (12%) eyes worsened due to complications. Conclusion: Adult‑onset Coats’ disease has less extensive involvement, more benign natural course, and a more favorable treatment outcome as against the childhood‑onset disease. The bilateral presentation emphasizes the need for regular follow‑up to detect possible future involvement of the fellow eye.

Correlation of radiological charicteristics of Coats’disease with pathology / 实用放射学杂志

Objective To investigate the CT and MRI findings of Coats’disease in comparison with pathology.Methods CT,MRI and ultrasonic features,FFA findings of eight patients of Coats’disease with histo-pathologically confirmed were analyzed retrospectively.CT scanning,routine MRI scanning and ultrasonic examination were performed in all eight patients.Results Unilateral eyeball was involved in all eight cases.On CT scanning,the density of the vitreous body was increased homogeneously which boundary was clear(n=8).The retina was thick(n=8).The anterior chamber depth was shallow(n=5).Multiple calcified foci occured in lens and vitreous body(n=1).The volume of affected eyeball increased(n=1).The affected eyeball shrinked(n=1).The difference of volume of bilateral eyeball was not obvious(n=6). Lens were thick and dislocation(n=5).On MRI scanning,the lesions in the vitreous body showed iso T1 and iso T2 signal (n=6),short T1 and long T2 signal(n=1),long T1 and long T2 signal(n=1).The retina showed short T2 signal(n=3).The vitreous body was filled with lesions(n=5).The lesions looked like‘V’sticked to retina(n= 3).On ultrasonic examination low echo was showed in the vitreous body(n=6),the ball wall bulged(n=8),retinal detachment(n=8).The echo of the ball wall was obviously enhanced,which indica-ted ossification(n=1).Strong echo calcified plaque was showed in one case.FFA showed retinal telangiectasia(n=8),retinal capillary zone(n=2),mutiple chestnut shaped aneurysms(n= 6),retinal neovascularization(n= 1 ).Pathological examination showed retinal telangiectasia with foam macrophages and lipid deposition.Conclusion Coats’disease carries some typical CT and MRI features.To summarize the radiologic features,the findings of FFA and ultrasonic inspection are helpful to diagnosis.