Korean J Ophthalmol.  2010 Dec;24(6):374-376. 10.3341/kjo.2010.24.6.374.

Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection for the Treatment of Adult Coats' Disease: A Case Report

• Kim J
• Park KH
• Woo SJ

• KMID: 1769094
• DOI: http://doi.org/10.3341/kjo.2010.24.6.374

Abstract

A 68-year-old woman presented with a visual field defect in her right eye. The fundus of her right eye showed multiple telangiectatic vessels, retinal hemorrhages, and subretinal exudates in the inferior peripheral retina. Nine months later, the subretinal exudates extended to the fovea despite treatment with laser photocoagulation. Cryotherapy was not possible at the time because of the posterior location of the retinal telangiectatic vessels. She was treated with a combination of photodynamic therapy (PDT) and intravitreal bevacizumab injection: three injections were given at 2-month intervals. After this combined therapy, her right fundus revealed a significant regression of abnormal retinal vessels and subretinal exudates. A fluorescein angiography showed no leakage from the abnormal retinal vessels. At 9 months after the combined therapy, she was able to maintain a stable visual acuity and visual field. This is the first case report that demonstrates the efficacy of the combined treatment of PDT and intravitreal bevacizumab injection in Coats's disease. This combined therapy is a kind of treatment modality for adult Coats' disease in cases which cryotherapy cannot be employed and are refractory to laser photocoagulation.

Keyword

Bevacizumab; Coats' disease; Photodynamic therapy

MeSH Terms

Aged
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Drug Therapy, Combination
Female
Fluorescein Angiography
Fundus Oculi
Humans
Intravitreal Injections
*Photochemotherapy
Retinal Telangiectasis/diagnosis/*drug therapy/physiopathology
Treatment Outcome
Visual Fields

Figure

• 

  Fig. 1 Serial montage fundus photographs (left) and fluorescein angiographs (middle and right) of the right eye. (A) Two days before photodynamic therapy (PDT). The subretinal exudates were threatening the fovea. Dotted circles indicate PDT treatment areas. Fluorescein angiography reveals dye leakage from the abnormal retinal vessels and hypofluorescence corresponding to the subretinal exudates. (B) Six months post-PDT, significant regression of the abnormal retinal vessels and subretinal exudates was observed. (C) Nine months post-PDT, the subretinal exudates shrank to become more distant from the fovea.

• 

  Fig. 2 Sequential changes in the distance between subretinal exudates and the fovea before and after photodynamic therapy (PDT). After PDT, the lesion-to-fovea distance increased gradually. DD=disc diameter.

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