Place of dexamethasone implant as an adjunctive treatment in Coats' disease: a retrospective single-center study

Abstract

Background: To evaluate the efficacy and safety of intravitreal dexamethasone implant as an adjunctive treatment to ablative therapy in Coats' disease.

Methods: Consecutive Coats patients examined between February 2012 and January 2024 who received Dexamethasone implant with a follow-up for over twelve months were retrospectively evaluated. The demographic assessment, clinical staging, therapies, and clinical and anatomic outcomes were noted.

Results: Of 15 total patients, four were excluded due to short follow-up. Ten patients (90.9%) were male, and all had unilateral involvement, whereas the only female patient (9.1%) had bilateral disease at presentation. At admission, the mean age was 14.82 ± 17.27 years (range 2-60 years). Seven of 12 eyes (58.33%) had stage 3a1, three eyes (25%) had stage 3a2, and two eyes (16.67%) had stage 2b disease. The mean follow-up duration was 65.73 ± 41.81 months (range 18-131 months). At the last visit, visual acuity remained stable in six of 12 eyes (50%), deteriorated in two eyes (16.67%), and improved at least one Snellen line in four eyes (33.33%). Transient IOP elevation was noted in eight eyes (66.67%). Cataract progression was documented in seven (58.33%) eyes, and four had cataract surgery (33.33%). Cyberknife therapy and subsequent vitrectomy surgery were performed in one eye (8.33%) due to a secondary vasoproliferative tumor occurrence. No other dexamethasone implant-related complication was noted.

Conclusions: Intravitreal dexamethasone implant can be a viable adjunctive option, especially in youngsters, to avoid frequent general anesthesia and in adults having massive macular exudation in addition to the conventional ablation treatments in Coats' patients.

Trial registration: Retrospectively registered. The study adhered to the principles outlined in the Declaration of Helsinki and was approved by the local ethics committee (Date: 12.02.2025, Number: 2025/05-24).

Keywords: Coats’ disease; Cyberknife; Dexamethasone intravitreal implant; Laser photocoagulation; Retinal telangiectasis.

Fig. 1

Case 6. Right eye. Composite color picture depicting the macular exudation and laser scars two months after the Dex implant administration

Fig. 2

Case 4. Right eye. At the presentation in 2016, A Color fundus picture revealing the extensive hard exudates with a foveal exudate plug. B Optical coherence tomography (OCT) image showing the highly elevated fovea. At the last visit in 2024, C Color fundus picture showing the partial resorption of the hard exudates and the laser scars. D Anterior segment image taken after the administration of the last (13th) Dex implant and concomitant cryotherapy administration

Fig. 3

Case 9. Left eye. At the presentation in 2022, A Color fundus picture depicting the massive exudation at the posterior pole, B Composite picture of the venous phase of fluorescein angiogram demonstrating the heavy fluorescein leakage and nonperfused temporal periphery, C Optical coherence tomography depicting the subretinal fluid accumulation, hyperreflective dots, and photoreceptor layer disruption. At the last visit in 2024, D Color fundus picture revealing the near total resolution of the hard exudates with some scarring, E Optical coherence tomography depicting the almost normalized foveal contour

Fig. 4

Case 3, Right eye. At the presentation in 2015, A Pre-treatment color image showing massive exudation with a wide foveal exudate plug. At the last visit in 2023, B Image taken at the final visit demonstrating the resolution of the exudates with the foveal scar and subretinal fibrotic streak