Surgical Treatment Of Coats Disease

In the treatment of Coats' Disease, conservative ablation methods such as laser photocoagulation and cryotherapy are preferred in the early stages and more comprehensive surgical interventions are required for advanced stages (Stage 3 and 4). At these stages, the expanding subretinal fluid and exudates limit the effectiveness of vascular ablation, necessitating the addition of drainage for subretinal fluid and exudates to the treatment. The most commonly accepted method is the transscleral external drainage of subretinal fluid, which is relatively safe as it preserves retinal integrity. However, the development of epiretinal membrane (ERM) are seen quite frequently, especially in patients who have received multiple ablative treatments. In patients with significant ERM, adding pars plana vitrectomy (PPV) and membrane peeling to the external drainage surgery can increase anatomical success by reducing the VEGF load in the vitreous and relieving retinal tractions, potentially reducing the need for additional ablation treatments. Considering the low visual expectations in Stage 3A-4 Coats' disease, the focus of post-surgical treatment expectations in these patients should shift from improving vision to preserving the globe and controlling the disease activity.