PDF
ePub
Citation
Print
Abstract
Purpose
To report the efficacy of intravitreal bevacizumab injection in adult patients with Coats'disease.
Case summary
Vascular telangiectasia, microaneurysms, circinate hard exudates, and macular edema were shown in the macula of two patients. Vascular abnormality was limited to≤6 clock hours in both cases. In case 1, the temporal retina demonstrates filigreelike vessels and capillary nonperfusion. In case 2, the nasal retina demonstrates aneurysmal dilatation and multiple microaneurysms. Intravitreal bevacizumab injection was administered in both cases. After 1 month, macular edema decreased. Laser photocoagulation was performed for vascular telangiectasia, microaneurysms, and capillary nonperfusion area. Then an additional decrease of macular edema was observed. Fluorescein leakage decreased, as well. After 1 month (case 1) and 2 months (case 2), macular edema increased. The second and third intravitreal reinjections were administered to each patient. Macular edema decreased.
Conclusions
We report two rare cases of Coats'disease in adult patients. Intravitreal bevacizumab injection in patients with Coats'disease can result in a rapid decrease of macular edema, which will then lead to rapid visual recovery and an opportunity for effective laser photocoagulation. We recommend that intraviteal bevacizumab injection be used in combination with laser photocoagulation for the treatment of Coats'disease.
References
1. Gomez Morales A. Coats' disease. Natural history and results of treatment. Am J Ophthalmol. 1965; 60:855–65.
2. Smithen LM, Brown GC, Brucker AJ, et al. Coats' disease diagnosed in adulthood. Ophthalmology. 2005; 112:1072–8.
3. Venkatesh P, Mandal S, Garg S. Management of Coats disease with bevacizumab in 2 patients. Can J Ophthalmol. 2008; 43:245–6.
4. Sun Y, Jain A, Moshfeghi DM. Elevated vascular endothelial growth factor levels in Coats disease: rapid response to pegaptanib sodium. Graefes Arch Clin Exp Ophthalmol. 2007; 245:1387–8.
5. Alvarez-Rivera LG, Abraham-Marin ML, Flores-Orta HJ, et al. Coats' disease treated with bevacizumab. Arch Soc Esp Oftalmol. 2008; 83:329–31.
6. Cahill M, O'Keefe M, Acheson R, et al. Classification of the spectrum of Coats' disease as subtypes of idiopathic retinal telangiectasis with exudation. Acta Ophthalmol Scand. 2001; 79:596–602.
7. Shields JA, Shields CL, Honavar SG, et al. Classification and management of Coats disease. The 2000 Proctor Lecture. Am J Ophthalmol. 2001; 131:572–83.
8. Jones JH, Kroll AJ, Lou PL, Ryan EA. Coats' disease. Int Ophthalmol Clin. 2001; 41:189–98.
9. Shields JA, Shields CL. Review: Coats disease. The 2001 LuEsther T. Mertz Lecture. Retina. 2002; 22:80–91.
10. Shields JA, Shields CL, Honavar SG, Demirci H. Clinical variations and complications of Coats disease in 150 cases. The 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001; 131:561–71.
11. Nucci P, Bandello F, Serafino M, Wilson ME. Selective photocoagulation in Coats' disease: ten-year follow-up. Eur J Ophthalmol. 2002; 12:501–5.
12. Couvillion SS, Margolis R, Mavrofjides E, et al. Laser treatment of Coats' disease. J Pediatr Ophthalmol Strabismus. 2005; 42:367–8.
13. Adam RS, Kertes PJ, Lam WC. Observations on the management of Coats' disease: less is more. Br J Ophthalmol. 2007; 91:303–6.
14. Shukla D, Chakraborty S, Behera UC, Kim R. Vitrectomy for epimacular membrane secondary to adult-onset Coats' disease. Ophthalmic Surg Lasers Imaging. 2008; 39:239–41.
15. Tripathi R, Ashton N. Electron microscopical study of Coat's disease. Br J Ophthalmol. 1971; 55:289–301.
16. Tolentino MJ, McLeod DS, Taomoto M, et al. Pathologic features of vascular endothelial growth factor-induced retinopathy in the nonhuman primate. Am J Ophthalmol. 2002; 133:373–85.
17. Tolentino MJ, Miller JW, Gragoudas ES, et al. Intravitreous injections of vascular endothelial growth factor produce retinal ischemia and microangiopathy in an adult primate. Ophthalmology. 1996; 103:1820–8.
18. Su CY, Chen MT, Wu WS, Wu WC. Concentration of vascular endothelial growth factor in the subretinal fluid of retinal detachment. J Ocul Pharmacol Ther. 2000; 16:463–9.
19. Black GC, Perveen R, Bonshek R, et al. Coats' disease of the retina (unilateral retinal telangiectasis) caused by somatic mutation in the NDP gene a role for norrin in retinal angiogenesis. Hum Mol Genet. 1999; 8:2031–5.
20. Luhmann UF, Lin J, Acar N, et al. Role of the Norrie disease pseudoglioma gene in sprouting angiogenesis during development of the retinal vasculature. Invest Ophthalmol Vis Sci. 2005; 46:3372–82.
Figure 1.
Case 1. (A) Capillary telangiectasia, microaneurysms, and circinate hard exudates are shown (in the right eye). (B) Angiographic photograph shows leakage in the telangiectactic vessels and microaneurysms. And temporal retina demonstrates filigreelike vessels and capillary nonperfusion. (C) Three optical coherence tomographic images of the right eye show improvement of macular edema before (top), 1 month after (middle) intravitreal bevacizumab injection, and 6 weeks after laser photocoagulation. (bottom). (D) 1 month after the third intravitreal bevacizumab injection, angiographic photograph shows decrease of leakage.
Figure 2.
Case 2. (A) Capillary telangiectasia, microaneurysms, and circinate hard exudates are shown (in the right eye). And aneurysmal dilatation of the inferotemporal retinal artery is also shown. (B) Angiographic photograph shows leakage in the telangiectatic vessels and microaneurysms. And the nasal retina demonstrates aneurysmaldilation and multiple microaneurysm. (C) Three optical coherence tomographic images of the right eye showing improvement of macular edema before (top), 1 month after (middle) intravitreal bevacizumab injection, and 1 month after laser photocoagulation (bottom). (D) After laser photocoagulation and intravitreal bevacizumab injection, photograph shows decrease of microaneuryms. And aneurysmal dilatation of inferotemporal retinal artery shows decrease of size.
XML Download