Treatment of coats' disease with combination therapy of intravitreal bevacizumab, laser photocoagulation, and sub-tenon corticosteroids

BACKGROUND AND OBJECTIVE: The authors investigate the efficacy of combination treatment with laser photocoagulation, intravitreal bevacizumab (IVB) (Avastin; Genentech, South San Francisco, CA), and sub-Tenon corticosteroids in Coats' disease. PATIENTS AND METHODS: Patient records at the Bascom Palmer Eye Institute were reviewed from August 2002 to January 2014. Primary outcome measures were anatomic success, globe salvage, and final visual acuity. RESULTS: Of the 26 patients (26 eyes) reviewed, 20 patients had stage 3A2, four patients had stage 3A1, and two patients had stage 2A. Mean follow-up time was 2.26 years. The median number of applications was five and three for laser and IVB, respectively. Five patients received sub-Tenon triamcinolone injections. Global salvage was achieved in all patients. Final visual acuity outcomes were reasonable: 20/20 to 20/50 in five patients, 20/60 to 20/100 in five patients, and 20/200 or less in 16 patients. CONCLUSION: Intravitreal injections of bevacizumab used in combination with repetitive laser photocoagulation therapy yielded anatomic success, global salvage, and reasonable visual acuity outcomes.