This protocol covers Coats' disease at Shields stage 1 (retinal telangiectasia only) or stage 2 (telangiectasia with exudation), in cases where the disease continues to progress after a prior treatment attempt.
Mild Coats' disease at Shields stages 1–2, characterised by retinal telangiectasia alone or by telangiectasia together with exudation, with documented disease progression.
Cryotherapy was applied as a prior line — indicated when laser photocoagulation was not possible or when thick exudation prevented the laser from reaching the vessels. It did not achieve resolution of exudative disease and retinal detachment. This protocol represents the escalation step taken after that failure.
The next step involves adjuvant intravitreal therapy administered in combination with laser photocoagulation and/or cryotherapy. The specific agents, their selection criteria, and the full treatment sequence are detailed in the complete protocol.
Improvement in visual acuity, decrease in central retinal thickness, resolution of exudates, decrease of macular oedema, and regression of dilated abnormal vessels.
DOI: 10.1159/000336906
1 Retinal telangiectasia only
2 Telangiectasia and exudation
Mild disease (1, 2) Laser photocoagulation/cryotherapy
Recently, intravitreal triamcinolone has been found to be effective in the treatment of Coats' disease as an adjuvant therapy.
The most recent development in the treatment of Coat's disease has been the use of anti-vascular endothelial growth factor (anti-VEGF) agents.
Today, anti-VEGF agents are used as adjuvant therapy to other treatment options, but clinical trials or case series with a large number of patients are limited due to the low incidence of the disease.
It is also very important to mention that anti-VEGF agents can be used only if the diagnosis of Coats' disease is confirmed and retinoblastoma excluded as it is known that intraocular injections can cause seeding of extraocular tissue in some cases of retinoblastoma.
This is in line with other reports, also suggesting an improvement in visual acuity, a decrease in central retinal thickness, resolution of exudates and no recurrence at an average 6-month follow-up, in patients treated with intravitreal triamcinolone as additional therapy.
Kaul et al. [64] recommend it as a future adjunctive treatment alongside traditional therapies, in accordance with the majority of other authors, as it seems to reduce macular oedema and exudates, improve or even stabilize visual acuity and enhance the regression of dilated abnormal vessels.
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