Clinical Ophthalmology (Jan 2021)
Experience with Intravitreal Ranibizumab as an Adjunct to Ablation Therapy in Eyes with Exudative Coats’ Disease
Abstract
Mohamed Nowara,1,2 Yousef A Fouad,1,3 Ihab Abdel Aziz,1,4 Ahmed M Habib,1,3 Mariam Al-feky,1,3 Hisham Hassan1 1Al Mashreq Eye Center, Cairo, Egypt; 2Department of Ophthalmology, Electricity Hospital, Cairo, Egypt; 3Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt; 4Memorial Institute for Ophthalmic Research, Giza, EgyptCorrespondence: Yousef A FouadDepartment of Ophthalmology, Ain Shams University Hospitals, Ramses Street, 11517 Abbasiya, Cairo, EgyptTel +201063781237Email [email protected]: Coats’ disease is a rare entity with retinal vascular telangiectasia that can progress to exudative retinal detachment, neovascular glaucoma, and a blind painful eye requiring enucleation. Despite recent therapeutic advances decreasing the need for enucleation, no consensus exists about the optimum management of exudative Coats’ disease. The use of intravitreal anti-vascular endothelial growth factor agents as an adjunct to ablation therapy has been shown to achieve favorable outcomes, but some reports suggest an increased incidence of vitreoretinal (VR) fibrosis and tractional retinal detachment (TRD).Methods: We retrospectively reviewed records of patients presenting with exudative Coats’ disease (stages 2 and 3) from April 2016 till November 2020. Extracted data included clinical and radiological assessment, stage (Shields’ classification), interventions, and follow-up.Results: Sixteen eyes were included in the final analysis, of which 4 (25%) were stage 2 and 12 (75%) were stage 3. All eyes underwent intravitreal ranibizumab injection combined with ablation therapy, 14 (87.5%) underwent cryotherapy, 4 (25%) underwent laser ablation, 3 (18.75%) underwent external subretinal fluid drainage, and 3 (18.75%) underwent buckle or vitrectomy surgery. After a median follow-up of 16 months, 11 eyes (68.75%) had complete resolution, 4 (25%) had incomplete resolution, and only one (6.25%) progressed but did not require enucleation. Three eyes (18.75%) developed VR fibrosis, but none progressed to TRD.Conclusion: Combining intravitreal ranibizumab injection with ablation therapy is effective in managing exudative Coats’ disease. External drainage should be preserved for when ablation therapy is not feasible. Future prospective trials with pre-defined outcomes are required.Keywords: Coats’ disease, Leber’s miliary aneurysms, exudative retinal detachment, vascular endothelial growth factor, cryotherapy
