Authors: Ihab Saad Othman, Magdy Moussa, Giza, Egypt

Advantages:

Coats disease is associated with vascular leaky telangiectatic vessels. Intravitreal triamcinolone injection modulates leaking vessels and is associated with subretinal fluid resorption that can be followed by laser peripheral photoablation.

Methods:

Twelve consecutive cases with Coats disease. Eleven cases presented in children and a single case presented in a 23-year-old male. Management included peripheral laser ablation and triamcinolone injection in 5 cases, subretinal fluid exodrainage, triamcinolone injection followed by laser ablation in 5 advanced cases, pars plana vitrectomy in the adult case and follow-up in a single case. Follow-up was by Retcam fundus photography and fluorescein angiography. Amblyopia therapy was done in 4 cases.

Effectiveness / Safety:

The five cases managed by triamcinolone injection and peripheral laser ablation responded to therapy by flattening of retinal detachment and absorption of macular exudates. Amblyopia therapy was successful in improving vision in the 4 cases. Exodrainage and TA injection successfully reposited the retina in 4 additional cases. The technique failed in one case. Three cases developed cortical cataract after the second injection of triamcinolone. Tractional retinal detachment developed in one case, for which vitrectomy was performed and was combined with excision of subretinal choroidal neovascular membrane. Adult case was successfully reposited after extensive epiretinal membranes dissection.

Take home message:

Triamcinolone has a potential role in improving rate of absorption of subretinal fluid and macular exudates in Coats disease. When combined with exodrainage and laser ablation in advanced Coats disease, effective retina reposition and globe salvage is achieved.