Abstract
Purpose:
This case is the first to our knowledge that demonstrates the efficacy of intravitreal aflibercept in bevacizumab-resistant, laser-naive macular edema (ME) in adult-onset Coats disease.
Methods:
A retrospective case report is presented.
Results:
A 74-year-old woman presented with central visual distortion in her right eye. Imaging and exam were consistent with adult-onset Coats disease with unilateral telangiectatic vessels, numerous macroaneurysms, and peripheral capillary dropout. There were also ME, lipid exudate, and localized hemorrhage. ME failed to respond to 4 intravitreal injections of bevacizumab but dramatically improved following initiation of aflibercept, with patient deferral of laser photocoagulation.
Conclusions:
To our knowledge, this is the first reported case of aflibercept as the sole treatment of bevacizumab-resistant ME in adult-onset Coats disease. Given the localized macular involvement more common to adult-onset Coats disease, antivascular endothelial growth factor (anti-VEGF) therapy may be sufficient, compared with classic childhood Coats disease, in which anti-VEGF therapy serves as an adjunct to laser photocoagulation or cryotherapy.
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