title: Advanced Coats' disease treated with intravitreal bevacizumab combined with laser vascular ablation.
abstract: OBJECTIVE
  To evaluate the impact of intravitreal bevacizumab combined with laser vascular ablation in the management of advanced Coats' disease presenting with exudative retinal detachment.
  
  
  METHODS
  This was a retrospective review of 24 children that presented with exudative retinal detachments associated with advanced Coats' disease. Mean patient age was 62 months (range 9-160 months). Presenting signs included retinal detachment in 24 children (100%), vascular telangiectasia in 24 children (100%), and retinal ischemia in 24 children (100%). Twenty of 24 children presented with elevated, vascular leakage in the fovea (83%). Two children presented with sub-retinal fibrosis associated with presumed long-standing retinal detachment without evidence of rhegmatogenous retinal detachment. Ten patients exhibited vascular alterations in the periphery of the second eye without clinical evidence of exudation. All 24 children were treated with a large-spot-size diode laser directly to areas of abnormal telangiectatic vasculature. All 24 children received intravitreal bevacizumab injection.
  
  
  RESULTS
  All 24 children had resolution of exudative retinal detachment, ablation of vascular telangiectasia, and anatomic improvement of the retina. No child exhibited progressive retinal detachment and no eye required enucleation. No cases of neovascular glaucoma were seen. Fellow eyes with peripheral vascular alterations showed no progression to exudative vasculopathy during the observation period. Intravitreal bevacizumab injection was not associated with endophthalmitis or systemically-observed complications.
  
  
  CONCLUSIONS
  Repetitive intravitreal bevacizumab combined with laser vascular ablation may be utilized effectively for advanced Coats' disease presenting with exudative retinal detachment.
authors.affiliation: Ocular Oncology and Retina, Miami, FL, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Villegas
authors.affiliation: Ocular Oncology and Retina, Miami, FL, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Gold
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Audina M
authors.initials: AM
authors.lastname: Berrocal
authors.affiliation: Ocular Oncology and Retina, Miami, FL, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
keywords: Coats’ disease; anti-VEGF; bevacizumab; laser ablation; retina