title: INTRAVITREAL RANIBIZUMAB AS AN ADJUNCTIVE TREATMENT FOR COATS DISEASE (6-YEAR FOLLOW-UP).
abstract: OBJECTIVE
  To evaluate the effectiveness of intravitreal ranibizumab in combination with laser photocoagulation in the management of Coats disease.
  
  
  METHODS
  Six intravitreal injections of 0.5 mg (0.05 mL) ranibizumab were performed, each 4 weeks apart. Correspondence to therapy was evaluated using visual acuity measurements and optical coherence tomography images. Six months after the initiation of treatment, laser photocoagulation was applied on the telangiectasias and on the surrounding ischemic areas, followed by a single intravitreal ranibizumab injection. Three months later, laser photocoagulation was repeated in purpose to prevent recurrence.
  
  
  RESULTS
  In the sixth month, no improvement in visual acuity was recorded, as thick circinate hard exudates still remained in the submacular space. Nevertheless, retinal detachment had completely subsided, and fluorescein angiography showed a significant decrease of leakage from the telangiectatic vessels. At the 12-month follow-up visit, an impressive improvement was recorded, with total absorption of the submacular exudate and visual acuity being 20/30. At the 20-month follow-up visit, his visual acuity was 20/20 and the retina was flat with no signs of macular edema or exudates. At the 6-year follow-up visit, the patient was absolutely stable.
  
  
  CONCLUSIONS
  Elevated vascular endothelial growth factor levels have been demonstrated in Coats disease. Anti-vascular endothelial growth factor agents assist to the decrease of vascular permeability of the capillary endothelial cells, thus increasing the efficiency of laser application.
authors.affiliation: *Department of Ophthalmology, University Hospital of Patras, Patras, Greece; †Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, United Kingdom; and ‡Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Marios
authors.initials: M
authors.lastname: Giannakopoulos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Drimtzias
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panteli
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vasilakis
authors.forename: Sotirios P
authors.initials: SP
authors.lastname: Gartaganis
mesh_terms: D000293:Adolescent; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage*; D058456:Retinal Telangiectasis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab