This document discusses surgical treatment options for advanced Coats' disease. It begins by classifying the stages of Coats' disease from mild telangiectasis to neovascular glaucoma. Primary treatments for early stages include laser and cryotherapy, while advanced stages often require surgery. The document describes a study comparing external drainage alone versus external drainage with vitrectomy in stage 3-4 disease, finding that adding vitrectomy resulted in fewer additional treatments needed and better anatomical and visual outcomes. In summary, external drainage with cryotherapy is effective for advanced Coats' disease but combining it with vitrectomy provides additional benefits.

1. SURGICAL TREATMENT OF
ADVANCED COATS’ DISEASE
QIOC, Feb 2021
SENGUL OZDEK
Gazi University, Ankara, TURKEY
www.sengulozdek.com, sozdek@gazi.edu.tr

2. COATS DISEASE
• Endothelium and pericyte disease:
Inner blood retina barrier defect
• Exudative (Tractional) RD

3. Coats Classification-Shields-revised
An overview of classification, management and outcomes
2019, Indian JO
1. ONLY TELANGIECTASIS
2. TELANGIECTASIS & EXUDATION
A. Extrafoveal Exudation
B. Foveal Exudation
1. No Subfoveal nodule
2. With Subfoveal nodule
3. + EXUDATIVE RD
A. Subtotal: 1.Extramacular, 2. Macular
B. total
4. + NVG
5. END STAGE DISEASE (Painful red eye)

4. COATS-Surgery
• Primary Treatment: Laser /Cryo
(Stage 1,2,3A)
• Anti-VEGF or Steroids
• Surgery: Stage 3-4
• External Drainage, Cryo +/-
Laser
• PPV-External Drainage
• Retinotomy for internal
drainage should be avoided!

5. Prognosis-Treatment
• Early presentation: more severe
disease: worse prognosis
• <3y age: usually present with stage
3
• 78%of Stage 4 (16% in total) Coats
are enucleated for painful eye
• Surgery to preserve the globe in
advanced cases (for cosmesis and
comfort)

6. 9 mo old boy, Stage 3B Coats
External Drainage-Cryo-IVB

7. 9 mo old boy, s/p
Ext. Drainage Cryo, 2 mo

8. 9 mo old boy, s/p Drainage Cryo, 6 mo
9 mo postop

9. 12y old boy, Stage 3B Coats
Only PPV-MP-Cryo-EL-IVB

11. Postop 5th mo VA: 0.1

12. 3y old girl, Stage 3B Coats
External Drainage-PPV-Cryo-Anti-
VEGF

13. 14mo old girl, Stage 4 Coats
External Drainage-PPV-Cryo-Anti-
VEGF

15. External Drainage Alone versus External Drainage
with Vitrectomy in Advanced Coats' Disease
Ucgul AY, Ozdek S, Ertop M, Atalay HT.
Am J Ophthalmol. 2020 Sept.
16 eyes External Drainage…..15 eye Ext Drain+PPV
All stage 3-4 Coats

16. Results
Need for additional treatment postop

17. Complications
No ERM-TRD in +PPV group

18. Take-home message
• External drainage + cryotherapy +/- LPC + IVB is
effective
• Addition of PPV:
• Less need for additional treatments during
follow-up,
• Better anatomical and visual results

19. Thank you!
Thanks to my Co-workers
Dr. H. Tuba Atalay
H. Baran Özdemir

20. Thank you!
HOPE TO MEET YOU
IN PANDEMIA FREE DAYS