A 10-Year Retrospective Review of Juvenile Coats Disease Treated with Adjuvant Intravitreal Bevacizumab Injections

Background: This study will analyse the visual outcomes of patients with juvenile Coats disease who were treated with adjuvant intravitreal bevacizumab injections, compared to a cohort who received conventional treatment without adjuvant therapy. Methods: Retrospective data was obtained from <18-year-old children with Coats disease known to the Queensland Children’s Hospital ophthalmology department between 1st January 2014 to 1st June 2024. After inclusion and exclusion criterion were applied, there were 18 participants (19 eyes) remaining in the study (9 in the adjuvant cohort; 10 in the conventional cohort). The conventional cohort was treated with conventional therapy (cryotherapy +/- laser photocoagulation +/- additional surgery). The adjuvant cohort was treated with conventional and adjuvant therapy (intravitreal bevacizumab injections). Results: The adjuvant and conventional cohorts both showed visual acuity (VA) improvement from baseline to disease resolution (logMAR -0.07 vs -0.13) (p=.461). Four eyes (40%) in the conventional cohort required additional surgery (e.g. vitrectomy, enucleation), whereas none had surgery in the adjuvant cohort (p=.049) over an average follow-up of 52.7 and 39.3 months respectively. Although time to disease resolution was similar, the conventional cohort (4 eyes; 40.0%) had significantly more disease recurrence in comparison to the adjuvant cohort (1 eye; 11.1%) (p=.039). The adjuvant group also had a longer mean time to disease recurrence (19.2 months) compared to the conventional group (13.4 months) (p=.044). There were no reported cases of tractional vitreoretinopathy following intravitreal bevacizumab with laser photocoagulation. Conclusions: Adjuvant intravitreal bevacizumab injections, when combined with laser photocoagulation, constitute a safe and effective treatment modality for juvenile Coats disease. This combined approach is associated with a reduced incidence of disease recurrence and a prolonged duration of disease quiescence.