Faculty Collaboration Database

Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction. Br J Ophthalmol 2012 Mar;96(3):356-9

Date

06/10/2011

Pubmed ID

21653215

DOI

10.1136/bjophthalmol-2011-300141

Scopus ID

2-s2.0-84857113746 (requires institutional sign-in at Scopus site)   112 Citations

Abstract

AIM: To evaluate the effect of supplemental intravitreal bevacizumab for management of Coats' disease.

METHODS: Retrospective analysis of eight patients with Coats' disease manifesting total or partial exudative retinal detachment where the retinal telangiectasia was treated with standard laser photocoagulation and/or cryotherapy plus additional intravitreal bevacizumab (1.25 mg/0.05 ml).

RESULTS: The mean patient age was 88 (range 7-240) months and 63% were male. Coats' disease was classified as stage 2 (n=1, 12%), 3a (n=3, 38%) and 3b (n=4, 50%). Features included retinal detachment (n=8, 100% with mean detachment extent involving 8 clock hours), telangiectasia (n=8, 100% with mean extent of 8 clock hours), peripheral retinal ischaemia on fluorescein angiography (n=7, 88%) and no evidence of neovascularisation. Treatment consisted of cryotherapy (n=8, 100%), laser photocoagulation (n=4, 50%) and bevacizumab intravitreal injection (n=8) with median number of one injection per eye (mean 1.75, and range 1-4 injections). After a mean follow-up of 8.5 months, resolution of retinopathy (n=8, 100%), Coats'-related subretinal fluid (n=8, 100%) and retinal exudation (n=6, 75%) was noted. However, vitreous fibrosis developed (n=4, 50%) at a mean of 5 months following a mean of 1.75 bevacizumab injections with three (38%) evolving into traction retinal detachment.

CONCLUSION: Coats' disease treated with intravitreal bevacizumab in addition to standard therapy can develop to vitreoretinal fibrosis and potentially traction retinal detachment. These tractional features are not often found in Coats' disease treated with standard measures without bevacizumab. Caution is advised in the use of bevacizumab for patients with Coats' disease.

Author List

Ramasubramanian A, Shields CL

Author

Aparna Ramasubramanian MD Associate Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Angiogenesis Inhibitors
Antibodies, Monoclonal, Humanized
Bevacizumab
Child
Child, Preschool
Combined Modality Therapy
Cryotherapy
Exudates and Transudates
Female
Fibrosis
Fluorescein Angiography
Follow-Up Studies
Humans
Infant
Intravitreal Injections
Laser Coagulation
Male
Retina
Retinal Detachment
Retinal Telangiectasis
Retrospective Studies
Risk Factors
Tissue Adhesions
Vascular Endothelial Growth Factor A
Young Adult