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Subfoveal Nodule Affecting Visual Prognosis in Coats Disease

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Purpose: To investigate the characteristics of subfoveal nodules in Korean patients with Coats disease and their association with visual outcomes Methods: A retrospective analysis was conducted within the medical records of patients with stage 2B or 3A1 Coats disease, including clinical features, imaging, presence of either a subfoveal nodule or macular fibrosis, and visual outcome. Results: Twelve patients were present with stage 2B or 3A1 Coats disease, and nine patients (75%) presented with subfoveal nodule. Between the group without subfoveal nodule and the group with subfoveal nodule, there were no significant differences in age (mean, 14.0 ± 1.7 years vs. 27.7 ± 21.8 years; p = 0.482), sex (all men), stage of the disease (stage 2B: three patients vs. eight patients, p > 0.999; stage 3A1: none vs. one patient, p > 0.999), extension of retinal exudation (mean, 7.7 hours vs. 4.1 hours; p = 0.209) and peripheral telangiectasia (mean, 3.7 hours vs. 4.2 hours; p = 0.727), and follow-up duration (mean, 65.0 months vs. 46.1 months; p = 0.600). There were significantly more patients with severe visual loss (≤20 / 200) among the patients with subfoveal nodule (none vs. seven patients, p = 0.045), and the cause for severe visual loss was macular fibrosis in all cases. Macular fibrosis developed significantly more frequently in the patients with subfoveal nodule (none vs. seven = patients, p = 0.045). Conclusions: This study is the first study covering the analysis of subfoveal nodules in Korean patients with Coats disease. The existence of a subfoveal nodule at the initial diagnosis serves as an indicator predicting the development of macular fibrosis and a less favorable visual outcome in the patients with Coats disease. A multicenter study with a larger patient pool and further studies toward the therapeutic approach for the subfoveal nodule and macular fibrosis are needed.

Abstract

Purpose: To investigate the characteristics of subfoveal nodules in Korean patients with Coats disease and their association with visual outcomes Methods: A retrospective analysis was conducted within the medical records of patients with stage 2B or 3A1 Coats disease, including clinical features, imaging, presence of either a subfoveal nodule or macular fibrosis, and visual outcome. Results: Twelve patients were present with stage 2B or 3A1 Coats disease, and nine patients (75%) presented with subfoveal nodule. Between the group without subfoveal nodule and the group with subfoveal nodule, there were no significant differences in age (mean, 14.0 ± 1.7 years vs. 27.7 ± 21.8 years; p = 0.482), sex (all men), stage of the disease (stage 2B: three patients vs. eight patients, p > 0.999; stage 3A1: none vs. one patient, p > 0.999), extension of retinal exudation (mean, 7.7 hours vs. 4.1 hours; p = 0.209) and peripheral telangiectasia (mean, 3.7 hours vs. 4.2 hours; p = 0.727), and follow-up duration (mean, 65.0 months vs. 46.1 months; p = 0.600). There were significantly more patients with severe visual loss (≤20 / 200) among the patients with subfoveal nodule (none vs. seven patients, p = 0.045), and the cause for severe visual loss was macular fibrosis in all cases. Macular fibrosis developed significantly more frequently in the patients with subfoveal nodule (none vs. seven = patients, p = 0.045). Conclusions: This study is the first study covering the analysis of subfoveal nodules in Korean patients with Coats disease. The existence of a subfoveal nodule at the initial diagnosis serves as an indicator predicting the development of macular fibrosis and a less favorable visual outcome in the patients with Coats disease. A multicenter study with a larger patient pool and further studies toward the therapeutic approach for the subfoveal nodule and macular fibrosis are needed.

참고문헌 (10)

  1. Coats G, "Forms of retinal diseases with massive exudation", R Lond Ophthalmol Hosp Rep, 17, pp.440~525 (1908)
  2. Shields JA, "Classification and management of Coats disease : the 2000 Proctor Lecture", Am J Ophthalmol, 131, pp.572~583 (2001)
  3. Khurana RN, "Subfoveal nodule in Coats’ disease", Clin Exp Ophthalmol, 33, pp.301~302 (2005)
  4. Jumper JM, "Macular fibrosis in Coats disease", Retina, 30(4 Suppl), pp.S9~S14 (2010)
  5. Daruich AL, "Subfoveal nodule in Coats’ disease : toward an updated classification predicting visual prognosis", Retina, 37, pp.1591~1598 (2017)
  6. Chang MM, "Coats’ disease : a study of 62 histologically confirmed cases", J Pediatr Ophthalmol Strabismus, 21, pp.163~168 (1984)
  7. Daruich A, "Extramacular fibrosis in Coats’ disease", Retina, 36, pp.2022~2028 (2016)
  8. Cahill M, "Classification of the spectrum of Coats’ disease as subtypes of idiopathic retinal telangiectasis with exudation", Acta Ophthalmol Scand, 79, pp.596~602 (2001)
  9. Matet A, "Macular telangiectasia type 1 : capillary density and microvascular abnormalities assessed by optical coherence tomography angiography", Am J Ophthalmol, 167, pp.18~30 (2016)
  10. Sigler EJ, "Retinal angiomatous proliferation with chorioretinal anastomosis in childhood Coats disease : a reappraisal of macular fibrosis using multimodal imaging", Retina, 35, pp.537~546 (2015)

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