Advanced Coats' disease: Management with repetitive aggressive laser ablation therapy

PURPOSE: To review the rates of globe salvage and final visual acuity outcomes for patients undergoing repetitive laser ablation therapy for advanced Coats' disease. METHODS: This study was a retrospective chart review of all patients diagnosed with primary Coats' disease treated on the Ocular Oncology Service of the Bascom Palmer Eye Institute from 1991-2006. Patients underwent repetitive diode laser ablation (two to nine sessions) to telangiectatic vessels and areas of exudative retinal detachment. Main outcome measures included ability to achieve globe salvage, final visual acuity, and anatomic success. RESULTS: Seventeen patients were identified who met all of the inclusion criteria for the study. All of the eyes in this study had advanced disease with some degree of exudation with or without a retinal detachment. The median length of follow-up was 10 months (mean, 21 months). The median number of laser applications required was 4.8 (mean, 5). Fourteen patients (82%) achieved anatomic success with complete resolution of the telangiectasis and exudative retinal detachments. Sixteen patients (94%) achieved globe salvage. The final visual acuity was excellent (20/20-20/50) in 7 patients (47%), moderate (20/60-20/100) in 1 patient (7%), and poor (worse than 20/200) in 7 patients (47%). CONCLUSION: A majority of patients with Coats' disease can achieve globe salvage and about half of patients can retain useful vision with aggressive repetitive diode laser therapy even if the disease is very advanced at presentation.