Long-Term Outcomes of Two-port Non-vitrectomy Endolaser Therapy in Moderate-to-severe Stage 3A Coats Disease

PURPOSE: To report the long-term outcomes of two-port non-vitrectomy endolaser therapy (TPNVE) in moderate-to-severe stage 3A Coats disease. METHODS: In this retrospective observational case series, patients with moderate-to-severe stage 3A Coats disease who were treated with TPNVE in a single tertiary referral vitreoretinal practice between March 2014 and May 2024 were included. The anatomic success rate, number of treatment sessions, and complications were analyzed. RESULTS: Of the 46 patients (47 eyes) included in the study, 33 (70.2%) eyes were stage 3A1, and the rest were stage 3A2. The mean (median, range) extent of ERD was 6.1 (5.0, 4.0-12.0) clock hours. The median (range) follow-up time was 67.7 (13.9-135.4) months. All 47 eyes achieved anatomic success with a median (range) treatment session of 2.0 (1-6) sessions. The median number of TPNVE treatments and conventional laser photocoagulation treatments was 1.2 (range, 1-2) and 0.0 (range, 0-4), respectively. Twenty (42.5%) eyes required only one session. There were 47 instances of recurrence in 27 eyes, of which over half (59.5%) took place in the first 6 months. Complications included cataracts in 11 (23.4%), vitreoretinal fibrosis in 11 (23.4%), subretinal fibrosis in 11 (23.4%), tractional retinal detachment in one (2.1%), and glaucoma in one (2.1%) of the eyes. CONCLUSIONS: TPNVE demonstrated efficacy in ablating abnormal vessels and reattaching the retina for moderate-to-severe stage 3A Coats disease. Approximately half of the eyes with an ERD extent of at least 4 clock hours achieved anatomical success after a single TPNVE surgery.