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Paediatric Coats’ disease

Early treatment critical, combined laser and anti-VEGF may be effective

Howard Larkin

Posted: Thursday, November 1, 2018


Bhamy Hariprasad Shenoy MBBS, MS, FICO, FRCOphth

Early detection and prompt, appropriate treatment of children with Coats’ disease result in favourable functional and anatomic outcomes with good globe salvage rates, Bhamy Hariprasad Shenoy MBBS, MS, FICO, FRCOphth, told the 2018 World Society of Paediatric Ophthalmology and Strabismus Subspecialty Day in Vienna.

Based on research conducted by Dr Shenoy and colleagues at Manchester Royal Eye Hospital, UK, adding anti-VEGF therapy to traditional laser photocoagulation may improve outcomes, he added.

The retrospective interventional case series involved 28 eyes with confirmed Coats’ disease in 26 patients aged 14 or under, followed for a mean of more than five years after treatment, ranging from 12 to 124 months, Dr Shenoy reported. Eleven eyes received green diode laser photocoagulation alone with a mean number of treatments of 2.7, while 17 eyes received a combination of laser and bevacizumab with a mean 2.0 treatments. Three eyes had additional vitreoretinal surgery to drain subretinal fluid and three had cataract extraction during follow-up.

GOOD OUTCOMES
Visual acuity stabilised or improved in 82% of eyes and worsened in 18% at last follow-up, Dr Shenoy reported. Mean VA at presentation ranged from logMAR -0.12 to 3, and at last follow-up from -0.2 to 3. Anatomic outcomes were also good. All eyes had attached retinas at last follow-up, no eye declined to phthisis or was enucleated and the globe was salvaged in all cases.

Dr Shenoy noted there is a wide variability in the clinical profile of paediatric Coats’ disease patients, which involves retinal vessel telangiectasia and aneurysms at stage 1, advancing to extra-foveal and foveal exudate in stages 2a and 2b, to exudative retinal detachment, secondary glaucoma and phthisis in stages 3 to 5. In this study 24 eyes were stage 2a or 2b, three stage 3 and one stage 4, with 16 patients aged 6 years or younger. Earlier age and good visual acuity at presentation were associated with favourable visual outcomes, Dr Shenoy added.

While Dr Shenoy did not break out differing outcomes by laser-only or combination laser-anti-VEGF groups, he noted that the series included long mean follow-up for several paediatric Coats’ disease patients receiving combination therapy.

“There is a definite role for anti-VEGF in improving outcomes,” he said, emphasising that early detection and treatment are the most crucial factors for improving the odds of a favourable outcome.

Bhamy Hariprasad Shenoy: drbhamy@gmail.com