Successful Use of Intravitreal Bevacizumab and Pascal Laser Photocoagulation in the Management of Adult Coats’ Disease
A 34 year-old male was referred to our department with rapidly reducing vision in the right eye over a 3-4 week period. He was otherwise medically healthy, with no relevant past ophthalmic history.\nAt presentation, his visual acuities were 6/18 and 6/5 in the right and left eyes, respectively. The intraocular pressures were 12 mmHg in each eye and slit-lamp examination of the anterior segment was unremarkable. Fundus examination revealed a subtotal temporal exudative retinal detachment of the right eye, with large intraretinal and subretinal exudates, encroaching the macula; with an associated large retinal vasoproliferative tumor affecting the temporal mid-periphery []. The left eye was clinically and angiographically normal.\nFluorescein angiography confirmed a profusely leaking temporal vasoproliferative tumor in the right eye with widespread telangiectatic vessels and aneurysmal dilatation of the capillary bed, in addition to diffuse areas of capillary non-perfusion of the right peripheral fundus []. Based on the features of the ophthalmic workup, the patient was diagnosed with vasoproliferative tumor of the retina (VPTR) with exudative retinal detachment secondary to Coats’ disease.\nThe patient was treated with two intravitreal Avastin (Genetech Inc., San Francisco, CA, USA) injections (1.25 mg), 4 weeks apart. Five days following the second injection, when he presented for laser treatment, the visual acuity of the right eye had improved to 6/5 unaided with no residual macular edema and complete regression of the VPTR. Panretinal photocoagulation was targeted towards areas of telangiectasia and peripheral ischemia, in addition to direct treatment of the VPTR using a 532 nm Pascal laser photocoagulator. A 3 × 3 square array pattern with pulse duration set at 20 ms and 200 micron spot size was used []. At the last follow-up, 12 months after initial intervention, visual acuity was maintained at 6/5, with no signs of recurrence.