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Graefes Arch Clin Exp Ophthalmol (2010) 248:15191521 DOI 10.1007/s00417-010-1366-1
CASE REPORT
Elevated vascular endothelial growth factor level in Coats disease and possible therapeutic role of bevacizumab
Yu-Guang He & Hao Wang & Biren Zhao & Jason Lee &
Dinesh Bahl & Jessica McCluskey
Received: 30 December 2009 /Revised: 3 March 2010 /Accepted: 11 March 2010 /Published online: 9 April 2010 # Springer-Verlag 2010
AbstractPurpose To compare intraocular vascular endothelial growth factor (VEGF) level in patients with and without Coats disease, and to report a case of Coats disease that responded to intravitreal injection of bevacizumab. Methods Intraocular fluid was obtained from four eyes with Coats disease (subretinal fluid in three eyes and aqueous in one eye) and from five eyes with rhegmatogenous retinal detachment (subretinal fluid in four eyes and vitreous in one eye). Intraocular VEGF level was compared between these two groups. In one eye with stage 2B Coats disease, macular edema, visual acuity, and intraocular VEGF level were compared before and after intravitreal injection of bevacizumab.
Results Mean intraocular VEGF level in eyes with Coats disease was 2,394.5 pg/ml, compared to 15.3 pg/ml in eyes with rhegmagenous retinal detachment. In the eye with stage 2B Coats disease, macular edema was reduced after bevacizumab injection, and the visual acuity improved from0.05 to 0.2. Intraocular VEGF level decreased from
1247 pg/ml to 20.4 pg/ml 1 month after the injection.
Conclusion Coats disease is associated with increased intraocular VEGF level. Bevacizumab may be a valuable adjunctive treatment for Coats disease.
Keywords Coats disease . Vascular endothelial growth factor. Bevacizumab
Introduction
Coats disease is idiopathic retinal telangiectasia which results in intraretinal and/or subretinal exudation, and exudative retinal detachment. Shields et al. classified Coats disease into five stages. Stage 1 has retinal telangiectasia only. Stage 2 has retinal telangiectasia and exudation (stage 2A: extrafoveal exudation; stage 2B: foveal exudation). Stage 3 is exudative retinal detachment (stage 3A: subtotal detachment; stage 3B: total retinal detachment). Stage 4 is total retinal detachment and glaucoma. Stage 5 is advanced end-stage disease such as phthisis bulbi [1].
Laser photocoagulation and cryotherapy remain the standard treatment for Coats disease. In cases where a significant bullous retinal detachment has developed, surgical reattachment may be required [13]. Bevacizumab, a monoclonal antibody against VEGF receptors, alone...