Coats' Disease Management and Treatment Strategies

Coats’ disease is a unilateral retinal vascular disorder characterised by telangiectatic and aneurysmal vessels leading to subretinal exudation and, in advanced stages, exudative retinal detachment. Management strategies aim to arrest vascular leakage, promote retinal reattachment and preserve vision. Early‐stage disease is often treated with ablative therapies such as laser photocoagulation or cryotherapy to obliterate abnormal vessels. In more advanced cases, intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have emerged as adjuncts to reduce exudation and facilitate subsequent photocoagulation. Surgical interventions, including subretinal fluid drainage and vitrectomy, are reserved for eyes with extensive detachment or secondary complications. Treatment decisions are guided by disease stage, patient age and retinal anatomy, with a trend towards combined multimodal approaches to improve anatomical and functional outcomes. Close follow-up is essential to detect recurrence of exudation or progression and to deliver timely retreatment.

Research from Nature Portfolio

Recent studies have examined clinical prognostic factors and multimodal treatment outcomes in diverse populations. A large retrospective analysis evaluated adult and paediatric eyes over two decades, revealing that combined laser and anti-VEGF protocols yield better long-term visual acuity than laser or cryotherapy alone. The study highlighted that the number of initial anti-VEGF injections correlates with significant letter gains in visual acuity and that adult‐onset patients may achieve superior final vision compared with childhood cases despite similar disease staging. Aggressive early intervention with adjunctive anti-VEGF therapy was associated with reduced need for secondary procedures and improved anatomical stability.

Coats' Disease Management and Treatment Strategies publication trend

The graph below shows the total number of articles in coats' disease management and treatment strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Telangiectasia: Dilated capillary networks in the peripheral retina that leak fluid and lipids.

Exudative retinal detachment: Separation of the neurosensory retina caused by accumulation of subretinal fluid.

Anti-VEGF therapy: Intravitreal injections that inhibit vascular endothelial growth factor to reduce vascular leakage.

Laser photocoagulation: Controlled application of laser energy to ablate abnormal retinal vessels and prevent leakage.

Optical coherence tomography angiography (OCTA): Imaging modality that visualises retinal and choroidal microvasculature without dye injection.

References

1. Clinical features and prognostic factors in 71 eyes over 20 years from patients with Coats’ disease in Korea. Scientific Reports (2021).
2. Idiopathic Peripheral Retinal Telangiectasia in Adults: A Case Series and Literature Review. Journal of Clinical Medicine (2021).
3. Optical Coherence Tomography Angiography Findings After Intravitreal Ranibizumab in Patients With Coats Disease. Frontiers in Medicine (2021).