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Dr. Md.Mominul IslamIspahani Islamia Eye Institute And Hospital
Dr. Md. Mominul Islam Fellow (Vitreo-Retina)Ispahani Islamia Eye Institute And Hospital Dhaka Bangladesh
Introduction
• Idiopathic • Characterized by: Telangiectatic aneurysmal retinal
vessels with sub-retinal exudation and fluid
History
Scottish ophthalmologist Coats
Massive sub retinal Exudation No significant vascular abnormalities
Massive sub retinal Exudation No significant vascular abnormalities Internal Hemorrhage
Massive sub retinal Exudation No significant vascular abnormalities Internal Hemorrhage
Massive sub retinal Exudation Frank retinal arterioles and venous malformation
Massive sub retinal Exudation Frank retinal arterioles and venous malformation
Group I Group II Group III
Histopathology
Clinical presentation
• Painless ophthalmic condition• Male affected 3 times more 3:1• No racial predilection
On examination
Decrease Visual acuity Corneal Oedema Strabismus Leukocoria Heterochromia Iris neovascularization
Tealangiectesia Intraretinal exudation Exudative RD Partial RD Total RD Retinal hemorrhage Retinal macrocyst
Ophthalmoscopic picture
Staging of Coats Disease
Am J Ophthalmol 2001;131:572–83
Systemic conditions
• Muscular dystrophy• Turner syndrome• Alport syndrome• Aplastic anemia
Ocular conditions that can simulate
Juvenile Coats disease
Retinoblastoma Retinal detachment Congenital cataract Norrie disease Persistent hyperplastic
primary vitreous Ocular toxocariasis
At any age Branch retinal vein
occlusion Vasculitis Ocular toxoplasmosis Type 1 idiopathic
juxtafoveolar telangiectasis
Diagnostic Testing
Treatment
The goal of treatment mainly is to close telangiectesia so that further leakage will not
occur
Treatment (contd)
Stage I• Documentation (CFP and FFA)• Follow up conservatively • Intervention (if sub-retinal fluid and
exudation develop)
Treatment (contd)Stage II to IV:
• Laser photocoagulation• Cryotherapy• Surgical Intervention
Repair Traction Hemorrhage RRDUSE of PDT in combination with IVB for adult coats. disease
Ablative therapies
Laser Photocoagulation
• Less severe cases of exudation• With or without RD• Vascular leakage• Non perfusion• NVE
Laser Photocoagulation
• Less severe cases of exudation• With or without RD• Vascular leakage• Non perfusion• NVE
Cryotherapy
• Laser is ineffective • Extensive sub-retinal exudation• RD• Drain sub retinal exudation
Pharmacologic therapiesIntravitreal Triamcinolone acetonide
Effective in macular Oedema Sub retinal exudation
Intravitreal Anti VEGF
• Surgical Intervention
Repair Traction Hemorrhage RRD End stage NVE Painful Blind eye
Outcome• Telangiectesia resolved (mean interval 15 months following
treatment) Completely 47% Partially 53%• Inactive telangiectesia and Old exudation (17 months following
Treatment)- 45%• Recurrence of Leakage and New telangiectesia (in 10 years)-7%• Most cases Stabilize /Improve- 76% Progressively worsening -8% Required Enucleation – 20%
Take Home Massage
• Coats disease is a serious eye disease• Repeated treatment are needed to stabilize
the affected eyes• Lifelong and serial monitoring required.• Careful distinction of coats disease from
retinoblastoma is important