Título / Title

BILATERAL COATS DISEASE: TWO CASE REPORTS

Introdução / Purpose

To report two cases of bilateral Coats disease.

Material e Método / Methods

#1:male, nine years old, with VA of counting fingers in OD and 20/20 in OS.
#2:female, twelve years old, with VA of 20/200 in OD and 20/80 in OS.
Fundus examination of both patients showed lipid exudation at the posterior pole and mid periphery. Color fundus photo,optical coherence tomography (OCT) and widefield fluorescein angiography were required.

Resultados / Results

Widefield angiography showed areas of peripheral hypofluorescence caused by no perfusion, and hyperfluorescence by leakage and macular edema in both eyes of both patients. It also confirmed the presence of telangiectasias. OCT confirmed the presence of macular edema and intraretinal exudates. Patients have no diabetes.The diagnosis of bilateral Coats disease was made and treatment was done with laser photocoagulation and intravitreal injection of bevacizumab in both eyes.Three months later,patient #1 kept same vision, however angiography revealed no ischemia or leakage. OCT showed reduction of macular edema and exudation. Ten days later, patient #2 had improved his VA in OS to 20/60, however signs of endophthalmitis was seen in OD. Pars plana vitrectomy (PPV) and intravitreal antibiotics was done.Fourty days after PPV, VA was 20/200 in OU.

Discussão e Conclusões / Conclusion

Coats disease is mostly unilateral. Herein, we describe two cases of bilateral manifestations of the disease -rarely found in ophthalmological departments- and how they were managed. We currently enjoy technological advances such as widefield angiography.This system enable the visualization of extrema peripheral retina, detecting vascular abnormalities of Coats disease that are not detected by traditional methods.
Anti-vegf injection showed to be an important ally in the control of edema, combined with traditionally used laser photocoagulation.
Adequate propaedeutics associated with high technology aided in the diagnosis and management of Coats disease.

Palavras Chave

Coats, photocoagulation, anti-VEGF, OCT, wide field, angiography