Adult-onset Coats disease: A systematic review and meta-analysis of imaging biomarkers and targeted therapies.
Catarina Francisco, Nisa Silva, Camiel J F Boon
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In 30 seconds
This systematic review and meta-analysis synthesized evidence on clinical features, imaging, mechanisms and treatment outcomes in adults (≥18 years) with confirmed Coats disease. It included 35 studies comprising 240 patients (250 eyes); findings were narratively synthesized, with random-effects meta-analysis when possible. Disease was usually unilateral and diagnosed at Shields Stage 2 or 3. Across heterogeneous studies, visual acuity was stabilized or improved in 57.1% of treated eyes, and recurrence occurred in 19.3%. Imaging commonly showed peripheral telangiectasia, lipid exudation and localized capillary nonperfusion.
Key findings
- Visual acuity was stabilized or improved in 57.1% of treated eyes; recurrence occurred in 19.3%.
- Laser photocoagulation and anti-VEGF agents were the most frequently described therapies; anatomical stabilization or reduced exudation was reported in approximately half of treated eyes.
- Better treatment outcomes were reported in earlier disease stages.
- Imaging consistently identified peripheral telangiectasia, lipid exudation and localized capillary nonperfusion.
Why it matters
Adult-onset Coats disease can involve the macula and may be accompanied by inflammatory signalling as well as VEGF-related permeability. The review brings together clinical, imaging and treatment observations that can help frame assessment of this uncommon condition, while highlighting that reported outcomes come from heterogeneous studies and do not establish the comparative effectiveness of specific therapies.
What to keep in mind
Evidence came from heterogeneous studies, and cytokine findings were reported in small cohorts. The authors call for prospective studies with standardized endpoints.