Pediatric Coats disease of stage 2 and greater managed with 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab_Chinese Journal of Ocular Fundus Diseases

Authors：

Deng Guangda , Liu Jinghua , Li Songfeng , Li Liang , Ma Jing , Yuan Mingzhen ,  Lu Hai

Beijing Tongren Hospital, Capital Medical University, Beijing Tongren Eye Center, Key Laboratory of Beijing Ophthalmology and Visual Science, Beijing 100730, China;

Corresponding author：

Lu Hai, Email: trdr_luhai@163.com

Keywords：

Coats disease; Angiogenesis inhibitors; Laser coagulation; Ranibizumab

DOI：

10.3760/cma.j.cn511434-20220517-00306

Video：

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Objective To investigate the efficacy of 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab (IVR) in treating stage 2 and greater pediatric Coats disease. Methods A retrospective, non-controlled clinical study. From February 2018 to August 2020, 21 eyes of 21 patients with Coats disease stage 2 and greater diagnosed by examination in the Eye Center of Beijing Tongren Hospital were included in the study. Among them, 20 patients were males; 1 patient was female. Mean age was 5.00±1.92 years old. Stage 2A, 2B, 3A, 3B, and 4 were 2, 8, 7, 2, and 2 eyes, respectively. All eyes underwent wide-field fundus color photography and fluorescein fundus angiography (FFA). Best corrected visual acuity (BCVA) was performed in 17 eyes. Abnormal dilated retinal blood vessels, interretinal and subretinal exudates were found in all eyes. Abnormally dilated capillaries and aneurysms in the retina was shown in FFA examination. All eyes underwent 532 nm laser photocoagulation using indirect ophthalmoscope combined with IVR. Patients with severe retinal detachment of stage 3B or greater were treated by external drainage of subretinal fluid (SRF). The subsequent treatment was the same as before. The follow-up time was 35.67±6.13 months. Relevant examinations were performed using the same equipment and methods before. The frequency of treatment, visual acuity changes, anatomic prognosis, and complications were observed. Results The frequency of eye photocoagulation was 2.43±0.98. The number of IVR treatments was 2.00±0.89. Three eyes were treated with SRF drainage in the first time. At the last follow-up, visual acuity improved, no change, and decreased in 5, 11, and 1 eyes after BCVA examination, respectively. In 21 eyes, the retina was in situ in 17 eyes; 5 eyes with retinal cysts. During the follow-up, cataract and vitreous hyperplasia occurred in 1 eye, which was treated by vitrectomy, and mild vitreous hyperplasia occurred in 1 eye. Conclusion Indirect ophthalmoscope 532 nm wavelength laser combined with IVR is an effective treatment for pediatric Coats disease.

Citation： Deng Guangda, Liu Jinghua, Li Songfeng, Li Liang, Ma Jing, Yuan Mingzhen, Lu Hai. Pediatric Coats disease of stage 2 and greater managed with 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab. Chinese Journal of Ocular Fundus Diseases, 2023, 39(1): 41-45. doi: 10.3760/cma.j.cn511434-20220517-00306 Copy

1.	Shields JA, Shields CL, Honavar SG, et al. Classification and management of Coats disease: the 2000 Proctor Lecture[J]. Br J Opthalmol, 2001, 131(5): 572-583. DOI: 10.1016/s0002-9394(01)00896-0.
2.	Daruich AL, Moulin AP, Tran HV, et al. Subfoveal nodule in Coat's disease: toward an updated classification predicting visual prognosis[J]. Retina, 2017, 37(8): 1591-1598. DOI: 10.1097/IAE.0000000000001399.
3.	Morris B, Foot B, Mulvihill A. A population-based study of Coats disease in the United Kingdom Ⅰ: epidemiology and clinical features at diagnosis[J]. Eye (Lond), 2010, 24(12): 1797-1801. DOI: 10.1038/eye.2010.126.
4.	Shapiro MJ, Chow CC, Karth PA, et al. Effects of green diode laser in the treatment of pediatric Coats disease[J]. Am J Ophthalmol, 2011, 151(4): 725-731. DOI: 10.1016/j.ajo.2010.10.024.
5.	阮露, 黄欣, 江睿, 等. 间接检眼镜下激光光凝治疗青少年型Coats病[J]. 中华眼底病杂志, 2014, 30(1): 42-45. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.011.Ruan L, Huang X, Jiang R, et al. Juvenile Coats disease successfully managed green diode laser using indirect ophthalmoscope[J]. Chin J Ocul Fundus Dis, 2014, 30(1): 42-45. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.011.
6.	Sun Y, Jain A, Moshfeghi DM. Elevated vascular endothelial growth factor levels in Coats disease: rapid response to pegaptanib sodium[J]. Graefe's Arch Clin Exp Ophthalmol, 2007, 245(9): 1387-1388. DOI: 10.1007/s00417-007-0559-8.
7.	He YG, Wang H, Zhao B, et al. Elevated vascular endothelial growth factor level in Coats' disease and possible therapeutic role of bevacizumab[J]. Graefe's Arch Clin Exp Ophthalmol, 2010, 248(10): 1519-1521. DOI: 10.1007/s00417-010-1366-1.
8.	Kase S, Rao NA, Yoshikawa H, et al. Expression of vascular endothelial growth factor in eyes with Coats' disease[J]. Invest Ophthalmol Vis Sci, 2013, 54(1): 57-62. DOI: 10.1167/iovs.12-10613.
9.	Kodama A, Sugioka K, Kusaka S, et al. Combined treatment for Coats disease: retinal laser photocoagulation combined with intravitreal bevacizumab injection was effective in two cases[J/OL]. BMC Ophthalmol, 2014, 14: 36[2014-03-25]. https://pubmed.ncbi.nlm.nih.gov/24666524/. DOI: 10.1186/1471-2415-14-36.
10.	Zhang L, Ke Y, Wang W, et al. The efficacy of conbercept or ranibizumab intravitreal injection combined with lasertherapy for Coats disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(7): 1339-1346. DOI: 10.1007/s00417-018-3949-1.
11.	Habib AM. Experience with intravitreal ranibizumab as an adjunct to ablation therapy in eyes with exudative Coats' disease[J]. Clin Ophthalmol, 2021, 15: 367-373. DOI: 10.2147/OPTH.S293030.
12.	中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Chinese Medical Association Ophthalmology Group. Quality control standard of vitreous injection for retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
13.	何晶晶, 孙祖华, 刘晓玲. 局部视网膜激光光凝治疗Coats病的疗效观察[J]. 中华眼底病杂志, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.He JJ, Sun ZH, Liu XL. Efficacy of focal photocoagulation on Coats disease[J]. Chin J Ocul Fundus Dis, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.
14.	安建斌, 马景学, 刘丽娅, 等. Coats病的分期与激光治疗[J]. 中国实用眼科杂志, 2008, 26(10): 1126-1128. DOI: 10.3760/cma.j.issn.1006-4443.2008.10.029.An JB, Ma JX, Liu LY, et al. Classification and laser treatment of Coats disease[J]. Chin Pract Opthalmol, 2008, 26(10): 1126-1128. DOI: 10.3760/cma.j.issn.1006-4443.2008.10.029.
15.	李瑞峰. 眼科激光治疗学概要[M]. 北京: 人民卫生出版社, 1998: 178.Li RF. The profile of ophthalmology laser therapy[M]. Beijing: People's Medical Publishing House, 1998: 178.
16.	Haritoglou C, Kook D, Neubauer A, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema[J]. Retina, 2006, 26(9): 999-1005. DOI: 10.1097/01.iae.0000247165.38655.bf.
17.	Li S, Deng G, Liu J, et al. The effects of a treatment combination of anti-VEGF injections, laser coagulation and cryotherapy on patients with type 3 Coat's disease[J]. BMC Ophthalmol, 2017, 17(1): 76. DOI: 10.1186/s12886-017-0469-4.
18.	Jiang L, Qin B, Luo XL, et al. Three-year follow-up of Coats disease treated with conbercept and 532-nm laser photocoagulation[J]. World J Clin Cases, 2020, 8(24): 6243-6251. DOI: 10.12998/wjcc.v8.i24.6243.
19.	Jun JH, Kim YC, Kim KS. Resolution of severe macular edema in adult Coats’ disease with intravitreal triamcinolone and bevacizumab injection[J]. Korean J Ophthalmol, 2008, 22(3): 190-193. DOI: 10.3341/kjo.2008.22.3.190.
20.	Sigler EJ, Randolph JC, Calzada JI, et al. Current management of Coats disease[J]. Surv Ophthalmol, 2014, 59(1): 30-46. DOI: 10.1016/j.survophthal.2013.03.007.
21.	Kaul S, Uparkar M, Mody K, et al. Intravitreal anti-vascular endothelial growth factor agents as an adjunct in the management of Coats disease in children[J]. Indian J Ophthalmol, 2010, 58(1): 76-78. DOI: 10.4103/0301-4738.58480.
22.	Wells JR, Hubbard GB 3rd. The effect of intravitreal bevacizumab in the treatment of Coats disease in children[J]. Retina, 2011, 31(2): 427-428. DOI: 10.1097/IAE.0b013e318203c01e.
23.	Galliard MC, Mataftsi A, Balmer A, et al. Ranibizumab in the management of advanced coats disease stages 3B and 4[J]. Retina, 2014, 34(11): 2275-2281. DOI: 10.1097/iae.0000000000000248.
24.	Yang Q, Wei W, Shi X, et al. Successful use of intravitreal ranibizumab injection and combined treatment in the management of Coats' disease[J]. Acta Ophthalmol, 2016, 94(4): 401-406. DOI: 10.1111/aos.13067.
25.	Ramasubramanian A, Shields CL. Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction[J]. Br J Ophthalmol, 2012, 96(3): 356-359. DOI: 10.1136/bjophthalmol-2011-300141.
26.	Bhat V, D'Souza P, Shah PK, et al. Risk of tractional retinal detachment following intravitreal bevacizumab along with subretinal fluid drainage and cryotherapy for stage 3B Coats' disease[J]. Middle East Afr J Ophthalmol, 2016, 23(2): 208-211. DOI: 10.4103/0974-9233.175895.
27.	Kusaka S. Surgical management of Coats disease[J]. Asia Pac J Ophthalmol (Phila), 2018, 7(3): 156-159. DOI: 10.22608/APO.201867.

1. Shields JA, Shields CL, Honavar SG, et al. Classification and management of Coats disease: the 2000 Proctor Lecture[J]. Br J Opthalmol, 2001, 131(5): 572-583. DOI: 10.1016/s0002-9394(01)00896-0.
2. Daruich AL, Moulin AP, Tran HV, et al. Subfoveal nodule in Coat's disease: toward an updated classification predicting visual prognosis[J]. Retina, 2017, 37(8): 1591-1598. DOI: 10.1097/IAE.0000000000001399.
3. Morris B, Foot B, Mulvihill A. A population-based study of Coats disease in the United Kingdom Ⅰ: epidemiology and clinical features at diagnosis[J]. Eye (Lond), 2010, 24(12): 1797-1801. DOI: 10.1038/eye.2010.126.
4. Shapiro MJ, Chow CC, Karth PA, et al. Effects of green diode laser in the treatment of pediatric Coats disease[J]. Am J Ophthalmol, 2011, 151(4): 725-731. DOI: 10.1016/j.ajo.2010.10.024.
5. 阮露, 黄欣, 江睿, 等. 间接检眼镜下激光光凝治疗青少年型Coats病[J]. 中华眼底病杂志, 2014, 30(1): 42-45. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.011.Ruan L, Huang X, Jiang R, et al. Juvenile Coats disease successfully managed green diode laser using indirect ophthalmoscope[J]. Chin J Ocul Fundus Dis, 2014, 30(1): 42-45. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.011.
6. Sun Y, Jain A, Moshfeghi DM. Elevated vascular endothelial growth factor levels in Coats disease: rapid response to pegaptanib sodium[J]. Graefe's Arch Clin Exp Ophthalmol, 2007, 245(9): 1387-1388. DOI: 10.1007/s00417-007-0559-8.
7. He YG, Wang H, Zhao B, et al. Elevated vascular endothelial growth factor level in Coats' disease and possible therapeutic role of bevacizumab[J]. Graefe's Arch Clin Exp Ophthalmol, 2010, 248(10): 1519-1521. DOI: 10.1007/s00417-010-1366-1.
8. Kase S, Rao NA, Yoshikawa H, et al. Expression of vascular endothelial growth factor in eyes with Coats' disease[J]. Invest Ophthalmol Vis Sci, 2013, 54(1): 57-62. DOI: 10.1167/iovs.12-10613.
9. Kodama A, Sugioka K, Kusaka S, et al. Combined treatment for Coats disease: retinal laser photocoagulation combined with intravitreal bevacizumab injection was effective in two cases[J/OL]. BMC Ophthalmol, 2014, 14: 36[2014-03-25]. https://pubmed.ncbi.nlm.nih.gov/24666524/. DOI: 10.1186/1471-2415-14-36.
10. Zhang L, Ke Y, Wang W, et al. The efficacy of conbercept or ranibizumab intravitreal injection combined with lasertherapy for Coats disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(7): 1339-1346. DOI: 10.1007/s00417-018-3949-1.
11. Habib AM. Experience with intravitreal ranibizumab as an adjunct to ablation therapy in eyes with exudative Coats' disease[J]. Clin Ophthalmol, 2021, 15: 367-373. DOI: 10.2147/OPTH.S293030.
12. 中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Chinese Medical Association Ophthalmology Group. Quality control standard of vitreous injection for retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
13. 何晶晶, 孙祖华, 刘晓玲. 局部视网膜激光光凝治疗Coats病的疗效观察[J]. 中华眼底病杂志, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.He JJ, Sun ZH, Liu XL. Efficacy of focal photocoagulation on Coats disease[J]. Chin J Ocul Fundus Dis, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.
14. 安建斌, 马景学, 刘丽娅, 等. Coats病的分期与激光治疗[J]. 中国实用眼科杂志, 2008, 26(10): 1126-1128. DOI: 10.3760/cma.j.issn.1006-4443.2008.10.029.An JB, Ma JX, Liu LY, et al. Classification and laser treatment of Coats disease[J]. Chin Pract Opthalmol, 2008, 26(10): 1126-1128. DOI: 10.3760/cma.j.issn.1006-4443.2008.10.029.
15. 李瑞峰. 眼科激光治疗学概要[M]. 北京: 人民卫生出版社, 1998: 178.Li RF. The profile of ophthalmology laser therapy[M]. Beijing: People's Medical Publishing House, 1998: 178.
16. Haritoglou C, Kook D, Neubauer A, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema[J]. Retina, 2006, 26(9): 999-1005. DOI: 10.1097/01.iae.0000247165.38655.bf.
17. Li S, Deng G, Liu J, et al. The effects of a treatment combination of anti-VEGF injections, laser coagulation and cryotherapy on patients with type 3 Coat's disease[J]. BMC Ophthalmol, 2017, 17(1): 76. DOI: 10.1186/s12886-017-0469-4.
18. Jiang L, Qin B, Luo XL, et al. Three-year follow-up of Coats disease treated with conbercept and 532-nm laser photocoagulation[J]. World J Clin Cases, 2020, 8(24): 6243-6251. DOI: 10.12998/wjcc.v8.i24.6243.
19. Jun JH, Kim YC, Kim KS. Resolution of severe macular edema in adult Coats’ disease with intravitreal triamcinolone and bevacizumab injection[J]. Korean J Ophthalmol, 2008, 22(3): 190-193. DOI: 10.3341/kjo.2008.22.3.190.
20. Sigler EJ, Randolph JC, Calzada JI, et al. Current management of Coats disease[J]. Surv Ophthalmol, 2014, 59(1): 30-46. DOI: 10.1016/j.survophthal.2013.03.007.
21. Kaul S, Uparkar M, Mody K, et al. Intravitreal anti-vascular endothelial growth factor agents as an adjunct in the management of Coats disease in children[J]. Indian J Ophthalmol, 2010, 58(1): 76-78. DOI: 10.4103/0301-4738.58480.
22. Wells JR, Hubbard GB 3rd. The effect of intravitreal bevacizumab in the treatment of Coats disease in children[J]. Retina, 2011, 31(2): 427-428. DOI: 10.1097/IAE.0b013e318203c01e.
23. Galliard MC, Mataftsi A, Balmer A, et al. Ranibizumab in the management of advanced coats disease stages 3B and 4[J]. Retina, 2014, 34(11): 2275-2281. DOI: 10.1097/iae.0000000000000248.
24. Yang Q, Wei W, Shi X, et al. Successful use of intravitreal ranibizumab injection and combined treatment in the management of Coats' disease[J]. Acta Ophthalmol, 2016, 94(4): 401-406. DOI: 10.1111/aos.13067.
25. Ramasubramanian A, Shields CL. Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction[J]. Br J Ophthalmol, 2012, 96(3): 356-359. DOI: 10.1136/bjophthalmol-2011-300141.
26. Bhat V, D'Souza P, Shah PK, et al. Risk of tractional retinal detachment following intravitreal bevacizumab along with subretinal fluid drainage and cryotherapy for stage 3B Coats' disease[J]. Middle East Afr J Ophthalmol, 2016, 23(2): 208-211. DOI: 10.4103/0974-9233.175895.
27. Kusaka S. Surgical management of Coats disease[J]. Asia Pac J Ophthalmol (Phila), 2018, 7(3): 156-159. DOI: 10.22608/APO.201867.

Chinese Journal of Ocular Fundus Diseases

Pediatric Coats disease of stage 2 and greater managed with 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab

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