Sequential multimodal therapy for senile-onset Coats disease

We report a rare case of senile-onset Coats disease presenting with severe macular exudation and subretinal fluid in a 70-year-old male who experienced progressive vision loss. Multimodal imaging excluded other exudative maculopathies and confirmed the diagnosis, guiding a personalized sequential therapeutic strategy. Initial intravitreal dexamethasone induction facilitated rapid reduction of subretinal fluid and inflammation, permitting targeted high-frequency fractionated laser photocoagulation of telangiectatic retinal vessels. Follow-up intravitreal aflibercept injections were administered to stabilize vascular permeability and maintain retinal dryness. Over 12 months, structural and functional outcomes were monitored with fundus photography, optical coherence tomography, and angiographic imaging. Best-corrected visual acuity improved from counting fingers at 20 cm to 0.15, while imaging demonstrated sustained resolution of macular edema, marked reduction of lipid exudation, and stable retinal architecture without active leakage. This case highlights the potential contribution of inflammatory processes in the pathogenesis of senile-onset Coats disease and suggests that an imaging-guided, multimodal approach combining corticosteroid induction, precise laser ablation, and anti-vascular endothelial growth factor therapy can achieve durable anatomical and functional stabilization in elderly patients with advanced exudative disease.