Management

The primary goal of treatment in Coats disease is to eradicate retinal telangiectasia, and preserve the globe and the vision.

Treatment should be tailored according to the disease's severity and staging. In children older than 15 years and in young adults, Coats disease is generally less aggressive; thus close observation only may be appropriate. In these patients, treatment should be considered in case of documented progression.

Argon laser photocoagulation is the treatment of choice in the early stages. Cryotherapy is also an important modality for treating peripheral telangiectasias associated with extensive exudation or subtotal retinal detachment. On an average, three to four sessions of treatment are required to control the disease process. Both techniques become less effective once the retina is detached and when more than two quadrants are affected.

In rare cases, a vitrectomy may be necessary to settle the detached retina. Steroid injection or vascular endothelial growth factor (VEGF) inhibitors (e.g. bevacizumab) may be used as adjunctive treatment.

Enucleation may be indicated in cases with extensive exudative retinal detachment and secondary neovascular glaucoma.ary hemangioma, retinal cavernous hemangioma, incontinentia pigmenti, idiopathic juxtafoveal telangiectasis, and toxocariasis.