Background: Coats' disease diagnosed in adulthood is an idiopathic, retinal exudative vascular disease without an inciting factor and has retinal features different from the childhood disease. Aim: To describe clinical features, treatment, and outcomes of eyes with Coats' disease first diagnosed in patients 35 years or older. Materials and Methods: Retrospective chart review of patients first diagnosed with Coats' disease at the age of 35 years or more at a tertiary eye care center between January 1995 and 2012. Eyes with retinal exudation or Coats'-like response from secondary causes were excluded. Results: Forty-five of 646 patients (7%) diagnosed with Coats' disease had adult-onset disease. Mean age at presentation was 47 years. Systemic hypertension was the most common (22%) systemic association and decreased vision the predominant presenting feature (83%). Localized (<6 clock h) presentation (74%) was unique to adults as against diffuse involvement (69%) in children (P < 0.001). Eyes were treated with laser photocoagulation 29 (60%), cryotherapy (4%), or both (2%) with surgical intervention in three (6%) eyes. Following treatment eight (35%) eyes improved, 11 (48%) eyes were stable while four (12%) eyes worsened due to complications. Conclusion: Adult-onset Coats' disease has less extensive involvement, more benign natural course, and a more favorable treatment outcome as against the childhood-onset disease. The bilateral presentation emphasizes the need for regular follow-up to detect possible future involvement of the fellow eye.

Coats’ disease of adult-onset in 48 eyes

Purpose: We present the case of an 18-year-old Caucasian male with a unilateral macular star and retinal vascular anomalies compatible with adult onset Coats’ disease Methods: Diagnosis was based on fundoscopic, fluorescein angiography and optical coherence tomography findings Results: The patient presented to our emergency department with complaints of low vision in his left eye (LE) detected 10 days before The best-corrected visual acuity in the LE was 20/50 Fundoscopy of the LE evidenced a complete macular star Optical coherence tomography showed increased retinal thickness, infiltration of the retinal wall, and detachment of the neuroepithelium Angiography revealed no appreciable diffusion in the macula Above the superior temporal (ST) arcade, anomalies in the retinal vasculature were found, with interruption of the peripheral vessels and vessels which were ‘sausage’-like After 1 month, the LE vision evolved to hand movements Laser photocoagulation was performed in the ST quadrant Intravitreal injection of bevacizumab 125 mg/005 ml and photodynamic therapy were performed without any significant changes, progression of ST serous detachment of the neuroepithelium, and finally progression to macular fibrosis Discussion: Coats’ disease is usually diagnosed in childhood, but rare cases may occur in adults Those cases usually have a more indolent course which was not observed in our patient When there is macular involvement, prognosis is more guarded, despite treatment

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Refractory coats' disease of adult onset.

espanolCaso clinico: Paciente varon que con 30 anos tuvo el primer episodio de enfermedad de Coats y recurrencia 14 anos mas tarde. Clinicamente ambos episodios tienen como sintoma de inicio vision borrosa y exploracion tipica de exudacion masiva retiniana con corona de exudados duros. La angiografia presenta hallazgos caracteristicos de telangiectasia retiniana con dilatacion anormal de vasos con hiperfluorescencia precoz y fuga tardia. Discusion: Coats es una entidad clinica poco frecuente y con grado de severidad variable, que hacen dificiles los estudios randomizados prospectivos. Pese a los hallazgos caracteristicos, hay que descartar otros diagnosticos tanto en el nino como en el adulto causantes de esa misma clinica. EnglishCase report: A male diagnosed with Coats disease at the age of 30 years, had a relapse of this condition 14 years later. His first symptom of blurred vision occurred in both episodes and similar findings of unilateral retinal exudation and lipid deposition at boundary were seen. Angiography showed the characteristic early hyperfluorescence of the telangiectasias and late leakage of dye. Discussion: Coats disease is relatively uncommon and, as the degree of involvement varies from case to case, a randomized, prospective study of treatment would probably not be feasible. Despite the characteristic features of this disease, the differential diagnoses must be considered in both children and adults

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R. Burdeus Gómez

Papers

Enfermedad de coats recidivante diagnosticada en sujeto adulto