Andrew S H Tsai, Chung-Ting Wang, Thomas C Lee, Aaron Nagiel, Kate Matsunaga, C Armitage Harper, Edward H Wood, Sang Jin Kim, Sungsoon Hwang, Michael J Shapiro, Michael P Blair, Cynthia A Toth, Nita Valikodath, Maria Ana Martinez-Castellanos, Matthew G J Trese, Antonio Capone, Kimberly Drenser, Zujaja Tauqeer, Cagri G Besirli, Emily Eton, Mary Elizabeth Hartnett, Christopher Bair, Brandon Kennedy, Shunji Kusaka, Fukutaro Mano, Emmanuel Y Chang, Prethy Rao, Patrick J Hunt, Mark K Walsh, Spencer Moore, Jonathan E Sears, Joseph Abraham, Matthew Schulgit, Tommaso Vagaggini, Polly A Quiram, Demetrios Vavvas, Nimesh A Patel, Sandra Hoyek, R V Paul Chan, Nayanika Challa, Thomas Mendel, Karan Sanjeev Dewan, David L Rogers, Atchara Amphornphruet, Wei-Chi Wu
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引用次数: 0
Abstract
Purpose: To evaluate the clinical outcomes and prognostic factors in unilateral Coats disease in the era of anti-VEGF therapy.
Design: Global, multicenter, retrospective case series.
Subjects: 656 eyes of 656 subjects with Coats disease were included in this study. Exclusion criteria were Coats disease secondary to retinitis pigmentosa as well as bilateral cases.
Methods: Clinical data from patients with Coats disease were collected from 20 ophthalmic practices around the world. We compared early-stage (stage 1-2) and advanced-stage (stage 3-5) Coats disease in terms of clinical characteristics and treatment modalities.
Main outcome meaures: Functional outcomes include achieving visual acuity (VA) of 0.3 logMAR or better and VA improvement or stability. Anatomical failure was defined as the development of phthisis, chronic retinal detachment, massive fibrosis, or the requirement for enucleation.
Results: Subjects with early-stage disease were significantly older, with a mean age of 17.4 ± 17.8 years, compared to 7.1 ± 7.1 years in the advanced-stage group (p < 0.001). There was a male predominance in both early and advanced stages (84.7%). Advanced disease was associated with a higher incidence of strabismus (20.2% vs. 6.7%, p < 0.001) and leukocoria (12.3% vs. 3.2%, p < 0.001). More subjects with early-stage disease received laser photocoagulation as monotherapy (44.7% vs. 21.1%, p < 0.001). Additionally, early-stage disease received more sessions of intravitreal anti-VEGF injections as adjunct therapy (4.4 ± 6.2 vs. 2.7 ± 2.1, p = 0.005). Factors associated with poorer functional outcomes included worse presenting visual acuity, advanced disease stage, and the presence of a foveal nodule. Worse presenting visual acuity and advanced disease stage was associated with lower likelihood of anatomical success while combination therapy increased the odds of anatomical success.
Conclusion: Unilateral Coats disease predominantly affects males, regardless of disease stage. Identifying a foveal nodule is crucial for visual prognosis. Laser photocoagulation remains the primary treatment. While anti-VEGF may prevent enucleation, its role in early-stage disease requires further clarification.
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