Panagiotis Stergiou

Coats' disease: treatment with intravitreal bevacizumab and laser photocoagulation.

Editor, C oats’ disease is characterized by retinal telangiectasia, macular oedema, exudation and, consequently, exudative retinal detachment. In its advanced stages, it may be complicated by total retinal detachment and glaucoma and may lead to phthisis bulbi (Shields et al. 2001). It usually presents unilaterally in 8–16-year-old males, although it may occur in patients as young as 4 months (Haller 2004). Exudation characterizing Coats’ disease can be attributed to increased vascular permeability caused by telangiectasia and aneurysms in the posterior pole and ⁄or the periphery, facilitating release of vascular endothelial growth factor (VEGF). This growth factor has been shown to cause telangiectasia, microvascular occlusion, microaneurysms, and, consequently, vascular leakage, thus promoting exudation (Sun et al. 2007). Recently, antibodies against VEGF (bevacizumab [Avastin ; Genentech], ranibizumab [Lucentis ; Novartis AG] and pegaptanib [Macugen ; Pfizer, Inc.]) have been employed in managing conditions characterized by exudation, such as age-related macular degeneration (AMD) and diabetic macular oedema (DMO) (Minnella et al. 2007). Corticosteroids have been known to reduce intraocular inflammation, tighten capillary walls and suppress cell proliferation. Intravitreal triamcinolone acetonide has been shown to be useful in increasing visual acuity (VA) in patients with diffuse DMO (Sivaprasad et al. 2006). We describe the management of Coats’ disease in a young adult male, in which laser photocoagulation along with bevacizumab ⁄ triamcinolone intravitreal injection were employed. A 17-year-old male was referred with a severe decrease in VA OD occurring over some weeks. Ophthalmic evaluations included non-standardized Snellen VA, and complete ophthalmic and fundus examination. Active neovascularization in the optic disc and ⁄or elsewhere was confirmed with fluorescein angiography (FA). The patient’s VA OD was 20 ⁄ 1000. Fundus examination revealed considerable exudation involving the posterior pole, and macroaneurysms and telangiectases in the temporal periphery (Fig. 1A). Localized telangiectases in the periphery combined with the overall clinical picture was compatible with Coats’ disease diagnosed in adulthood. These findings were confirmed in FA (Fig. 2A). Treatment