Optical Coherence Tomography Angiography Findings After Intravitreal Ranibizumab in Patients With Coats Disease

Abstract

The aim of this retrospective study was to describe the vascular features in eyes with Coats disease, using optical coherence tomography angiography (OCTA), at baseline and after 3 monthly intravitreal injections of ranibizumab. Fifteen eyes of 15 consecutive patients affected by Coats' disease were recruited in this study. All patients underwent the best-corrected visual acuity (BCVA) evaluation, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), multicolor imaging, structural Spectral Domain (SD)-OCT and OCTA at baseline and 1 month after the third monthly ranibizumab injection (loading phase). Fifteen patients completed the study, of whom nine were males and six females. Mean age was 20.4 ± 2 years. BCVA was 0.46 ± 0.11 logMar and 0.47 ± 0.12 logMar at baseline and after treatment, respectively (p = 0.164). SD-OCT revealed no significant decrease in central macular thickness (486.33 μm ± 93.37 at baseline vs. 483.4 μm ± 80.97 after treatment; p = 0.915). The subretinal exudates persisted in macular region after intravitreal injections. OCTA showed a general vascular rarefaction in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillary (CC) that did not change after loading phase. This study showed no functional and vascular improvement following 3 monthly ranibizumab injections. OCTA, non-invasive technique, could be useful during follow up of these patients and provide a better understand of pathogenesis of this disorder.

Keywords: Coats disease; OCTA; SD-OCT; anti-VEGF injections; retinal vascular features.

Figure 1

Left eye of a male 20 years old patients before and after 3 monthly intravitreal injection of ranibizumab. At baseline, multicolor shows foveal exudates and retinal telangiectasia temporally to the fovea (A). OCTA images of the superficial capillary plexus (SCP) shows few areas of capillary hypoperfusion with a slight increased FAZ area (B). The deep capillary plexus (DCP) (C) shows irregularly dilatated small vessels, increased vascular rarefaction, in particular temporally the fovea. The CC reveals few areas of no flow signal due to a posterior shadow effect from intraretinal exudates (D). The structural spectral domain optical coherence tomography (SD-OCT) B-scan of each OCTAngiography (OCTA) image reveals some intraretinal exudates and cysts temporally the foveal region. After loading phase, the multicolor image reveals no change in foveal exudates and in teleangectasia temporally to the foveal region (A1). At OCTA no significant improvement in capillary drop out and anomalies in vessel size are found in superficial and deep capillary networks, respectively (B1,C1). In CC persists few areas of no flow signal due to the presence of intraretinal exudates (D1). No structural OCT changes was evident after treatment.