Dr. Md.

Mominul Islam
Ispahani Islamia Eye Institute And Hospital

Dr. Md. Mominul Islam

Fellow (Vitreo-Retina)
Ispahani Islamia Eye Institute And
Hospital Dhaka
Bangladesh
 Introduction
• Idiopathic
• Characterized by:
Telangiectatic aneurysmal retinal
vessels with sub-retinal exudation and fluid
History
 Scottish ophthalmologist Coats

Group I Group II Group III

 Massive sub  Massive

 Massivesub
subretinal
retinal  Massive
 Massivesub
sub
retinal Exudation Exudation
Exudation retinal
retinalExudation
Exudation
 No significant  No
Nosignificant
significant  Frank
Frankretinal
retinal
vascular vascular
vascularabnormalities
abnormalities arterioles
arteriolesand
andvenous
venous
abnormalities  Internal
Internal malformation
malformation
Hemorrhage
Hemorrhage
Histopathology
 Clinical presentation
• Painless ophthalmic condition
• Male affected 3 times more 3:1
• No racial predilection
 On examination

 Tealangiectesia
 Decrease Visual acuity
 Intraretinal
 Corneal Oedema
exudation
 Strabismus
 Exudative RD
 Leukocoria
 Partial RD
 Heterochromia
 Total RD
 Iris neovascularization
 Retinal hemorrhage
 Retinal macrocyst
Ophthalmoscopic picture
Staging of Coats Disease

Am J Ophthalmol 2001;131:572–83
 Systemic conditions

• Muscular dystrophy
• Turner syndrome
• Alport syndrome
• Aplastic anemia
 Ocular conditions that can
simulate
Juvenile Coats disease At any age

 Retinoblastoma  Branch retinal vein

 Retinal detachment occlusion
 Congenital cataract  Vasculitis
 Norrie disease  Ocular toxoplasmosis
 Persistent hyperplastic  Type 1 idiopathic
primary vitreous juxtafoveolar telangiectasis
 Ocular toxocariasis
Diagnostic Testing
 Treatment

The goal of treatment mainly is to close

telangiectesia so that further leakage will not
occur
 Treatment (contd)
Stage I
• Documentation (CFP and FFA)
• Follow up conservatively
• Intervention (if sub-retinal fluid and
exudation develop)
 Treatment (contd)
Stage II to IV:

• Laser photocoagulation
• Cryotherapy
• Surgical Intervention

Repair Traction
Hemorrhage
RRD
USE of PDT in combination with IVB for adult coats.
disease
 Ablative therapies

Laser
LaserPhotocoagulation
Photocoagulation Cryotherapy

••Less
Lesssevere
severecases
casesof
of • Laser is ineffective
exudation
exudation • Extensive sub-retinal
••With
Withororwithout
withoutRD
RD exudation
••Vascular
Vascularleakage
leakage • RD
••Non
Nonperfusion
perfusion • Drain sub retinal
••NVE
NVE exudation
 Pharmacologic therapies
Intravitreal Triamcinolone acetonide
 Effective in macular Oedema
 Sub retinal exudation
Intravitreal Anti VEGF
• Surgical Intervention

 Repair Traction
 Hemorrhage
 RRD
 End stage NVE
 Painful Blind eye
 Outcome
• Telangiectesia resolved (mean interval 15 months following
treatment)
Completely 47%
Partially 53%
• Inactive telangiectesia and Old exudation (17 months following
Treatment)- 45%
• Recurrence of Leakage and New telangiectesia (in 10 years)-7%
• Most cases
Stabilize /Improve- 76%
Progressively worsening -8%
Required Enucleation – 20%
 Take Home Massage
• Coats disease is a serious eye disease
• Repeated treatment are needed to stabilize
the affected eyes
• Lifelong and serial monitoring required.
• Careful distinction of coats disease from
retinoblastoma is important