Long-term outcomes of adjuvant intravitreal injection of conbercept therapy in juvenile Coats disease_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Liang ,  Li Songfeng , Liu Jinghua , Deng Guangda , Ma Jing , Yuan Mingzhen , Lu Hai

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China;

Corresponding author：

Li Songfeng, Email: lsf_0309@163.com

Keywords：

Coats disease; Conbercept; Angiogenesis inhibitors; Laser coagulation

DOI：

10.3760/cma.j.cn511434-20220523-00316

Video：

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Objective To study the long-term effects and outcomes of adjuvant intravitreal injection of conbercept (IVC) therapy in juvenile Coats disease. Methods A retrospective case series study. From January 1, 2015 to December 31, 2018, 40 patients (40 eyes) who were diagnosed as juvenile Coats disease at Beijing Tongren Hospital Affiliated to Capital Medical University were included in the study. Among them, there were 37 males (37 eyes) and 3 females (3 eyes). All patients had unilateral Coats disease. The average age was 55.00 (44.75, 81.25) months. Five eyes were in stage 2B, 15 eyes were in stage 3A, 19 eyes were in stage 3B and 1 eye was in stage 4. Idiopathic retinal vascular telangiectasia associated with extensive subretinal fluid (SRF) (stage 3 or above) or massive foveal exudation and edema (stage 2B) were found in fundus examination. All affected eyes underwent wide-field color fundus images and fluorescein fundus angiography. Thirty-one eyes underwent best corrected visual acuity (BCVA) examination. The BCVA was carried out using a standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity. All cases received adjuvant IVC combined with treatments such as retinal photocoagulation. The average number of injections was 4 (1, 5). The average follow-up after initial treatment was 59.00 (52.50, 63.00) months. The changes in BCVA, occlusion of abnormal blood vessels in fundus, absorption of SRF and ocular and systemic complications were observed. Results At last follow-up, among 31 affected eyes with the examination of BCVA, 13 (32.5%, 13/40) eyes had an improved vision, 12 eyes(30.0%, 12/40) had a stable vision and 6 eyes (15.0%, 6/40) had a decreased vision. The difference between average logMAR BCVA of the affected eyes in each stage after treatment and that before treatment was not statistically significant (Z=－0.56, －1.80, －0.84; P＞0.05). Abnormal blood vessels in fundus were all partially or completely occluded, and SRF was obviously or completely absorbed in all cases; of which, 28 eyes (70.0%, 28/40) were completely occluded, and 12 eyes (30.0%, 12/40) were partially occluded. No patient underwent eye enucleation. Nineteen eyes (47.5%, 19/40) developed vitreoretinal fibrosis; 8 eyes (20.0%, 8/40) developed tractional retinal detachment; 15 eyes (37.5%, 15/40) developed complicated cataract. None had ocular or systemic complications related to IVC therapy during follow-up. Conclusions IVC combined with classic treatments such as photocoagulation in juvenile Coats disease can keep or improve the visual acuity in most juvenile patients by reducing SRF. IVC is a long-term safe and effective adjuvant therapy in juvenile Coats disease.

Citation： Li Liang, Li Songfeng, Liu Jinghua, Deng Guangda, Ma Jing, Yuan Mingzhen, Lu Hai. Long-term outcomes of adjuvant intravitreal injection of conbercept therapy in juvenile Coats disease. Chinese Journal of Ocular Fundus Diseases, 2023, 39(1): 46-50. doi: 10.3760/cma.j.cn511434-20220523-00316 Copy

1.	Shields JA, Shields CL, Honavar SG, et al. Classification and management of Coats disease: the 2000 Proctor Lecture[J]. Am J Ophthalmol, 2001, 131(5): 572-583. DOI: 10.1016/s0002-9394(01)00896-0.
2.	惠延年. Coats病的中文名称应统一[J]. 中华眼底病杂志, 2015, 31(5): 485-486. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.019.Hui YN. The Chinese name of Coats disease should be unified[J]. Chin J Ocul Fundus Dis, 2015, 31(5): 485-486. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.019.
3.	Sen M, Shields CL, Honavar SG, et al. Coats disease: an overview of classification, management and outcomes[J]. Indian J Ophthalmol, 2019, 67(6): 763-771. DOI: 10.4103/ijo.IJO_841_19.
4.	Dalvin LA, Udyaver S, Lim LS, et al. Coats disease: clinical features and outcomes by age category in 351 cases[J]. J Pediatr Ophthalmol Strabismus, 2019, 56(5): 288-296. DOI: 10.3928/01913913-20190716-01.
5.	Nowara M, Fouad YA, Abdel Aziz I, et al. Experience with intravitrealranibizumab as an adjunct to ablation therapy in eyes with exudative Coats' disease[J]. Clin Ophthalmol, 2021, 15: 367-373. DOI: 10.2147/OPTH.S293030.
6.	Jiang L, Qin B, Luo XL, et al. Three-year follow-up of Coats disease treated with conbercept and 532-nm laser photocoagulation[J]. World J Clin Cases, 2020, 8(24): 6243-6251. DOI: 10.12998/wjcc.v8.i24.6243.
7.	Zhang L, Ke Y, Wang W, et al. The efficacy of conbercept or ranibizumab intravitreal injection combined with laser therapy for Coats' disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(7): 1339-1346. DOI: 10.1007/s00417-018-3949-1.
8.	Shields JA, Shields CL, Honavar SG, et al. Clinical variations and complications of Coats disease in 150 cases: the 2000 Sanford Gifford Memorial Lecture[J]. Am J Ophthalmol, 2001, 131(5): 561-571. DOI: 10.1016/s0002-9394(00)00883-7.
9.	Schulze-Bonsel K, Feltgen N, Burau H, et al. Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test[J]. Invest Ophthalmol Vis Sci, 2006, 47(3): 1236-1240. DOI: 10.1167/iovs.05-0981.
10.	中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Fundus Disease Group of Ophthalmology Branch of Chinese Medical Association. Quality control standard for intravitreal injection of retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
11.	何晶晶, 孙祖华, 刘晓玲. 局部视网膜激光光凝治疗Coats病的疗效观察[J]. 中华眼底病杂志, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.He JJ, Sun ZH, Liu XL. Efficacy of focal photocoagulation on Coats disease[J]. Chin J Ocul Fundus Dis, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.
12.	Toi M, Matsumoto T, Bando H. Vascular endothelial growth factor: its prognostic, predictive, and therapeutic implications[J]. Lancet Oncol, 2001, 2(11): 667-673. DOI: 10.1016/S1470-2045(01)00556-3.
13.	Mano F, Matsushita I, Kondo H, et al. Vitrectomy and external drainage of subretinal fluid containing high concentration of vascular endothelial growth factor for advanced coats disease[J/OL]. Sci Rep, 2021, 11(1): 19333[2021-09-29]. https://pubmed.ncbi.nlm.nih.gov/34588604/. DOI: 10.1038/s41598-021-98968-9.
14.	Kase S, Rao NA, Yoshikawa H, et al. Expression of vascular endothelial growth factor in eyes with Coats' disease[J]. Invest Ophthalmol Vis Sci, 2013, 54(1): 57-62. DOI: 10.1167/iovs.12-10613.
15.	Liang T, Xu Y, Zhu X, et al. Aqueous humour cytokines profiles in eyes with Coats disease and the association with the severity of the disease[J]. BMC Ophthalmol, 2020, 20(1): 178. DOI: 10.1186/s12886-020-01421-0.
16.	Stanga PE, Jaberansari H, Bindra MS, et al. Transcleral drainage of subretinal fluid, anti-vascular endothelial growth factor, and wide-field imaging-guided laser in Coats exudative retinal detachment[J]. Retina, 2016, 36(1): 156-162. DOI: 10.1097/IAE.0000000000000669.
17.	Kang HG, Kim JD, Choi EY, et al. Clinical features and prognostic factors in 71 eyes over 20 years from patients with Coats' disease in Korea[J/OL]. Sci Rep, 2021, 11(1): 6124[2021-03-17]. https://pubmed.ncbi.nlm.nih.gov/33731773/. DOI: 10.1038/s41598-021-85739-9.
18.	Li H, Lei N, Zhang M, et al. Pharmacokinetics of a long-lasting anti-VEGF fusion protein in rabbit[J]. Exp Eye Res, 2012, 97(1): 154-159. DOI: 10.1016/j.exer.2011.09.002.
19.	Van Bergen T, Etienne I, Cunningham F, et al. The role of placental growth factor (PIGF) and its receptor system in retinal vascular diseases[J]. Prog Retin Eye Res, 2019, 69: 116-136. DOI: 10.1016/j.preteyeres.2018.10.006.
20.	Chiu HH, Wan MJ, Kertes PJ, et al. Visual outcomes after treatment in pediatric patients with Coats' disease[J]. Can J Ophthalmol, 2019, 54(6): 647-652. DOI: 10.1016/j.jcjo.2019.02.004.
21.	Liang T, Peng J, Zhang Q, et al. Management of stage 3B Coats disease: presentation of a combined treatment modality and long-term follow-up[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(9): 2031-2038. DOI: 10.1007/s00417-020-04739-z.
22.	Ramasubramanian A, Shields CL. Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction[J]. Br J Ophthalmol, 2012, 96(3): 356-359. DOI: 10.1136/bjophthalmol-2011-300141.
23.	Gaillard MC, Mataftsi A, Balmer A, et al. Ranibizumab in the management of advanced Coats disease stages 3B and 4: long-term outcomes[J]. Retina, 2014, 34(11): 2275-2281. DOI: 10.1097/IAE.0000000000000248.
24.	Daruich A, Matet A, Tran HV, et al. Extramacular fibrosis in Coats' disease[J]. Retina, 2016, 36(10): 2022-2028. DOI: 10.1097/IAE.0000000000001013.
25.	Zheng XX, Jiang YR. The effect of intravitreal bevacizumab injection as the initial treatment for Coats' disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(1): 35-42. DOI: 10.1007/s00417-013-2409-1.
26.	Bergstrom CS, Hubbard GB 3rd. Combination intravitreal triamcinolone injection and cryotherapy for exudative retinal detachments in severe Coats disease[J]. Retina, 2008, 28(Suppl 3): S33-37. DOI: 10.1097/IAE.0b013e318159ecad.

1. Shields JA, Shields CL, Honavar SG, et al. Classification and management of Coats disease: the 2000 Proctor Lecture[J]. Am J Ophthalmol, 2001, 131(5): 572-583. DOI: 10.1016/s0002-9394(01)00896-0.
2. 惠延年. Coats病的中文名称应统一[J]. 中华眼底病杂志, 2015, 31(5): 485-486. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.019.Hui YN. The Chinese name of Coats disease should be unified[J]. Chin J Ocul Fundus Dis, 2015, 31(5): 485-486. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.019.
3. Sen M, Shields CL, Honavar SG, et al. Coats disease: an overview of classification, management and outcomes[J]. Indian J Ophthalmol, 2019, 67(6): 763-771. DOI: 10.4103/ijo.IJO_841_19.
4. Dalvin LA, Udyaver S, Lim LS, et al. Coats disease: clinical features and outcomes by age category in 351 cases[J]. J Pediatr Ophthalmol Strabismus, 2019, 56(5): 288-296. DOI: 10.3928/01913913-20190716-01.
5. Nowara M, Fouad YA, Abdel Aziz I, et al. Experience with intravitrealranibizumab as an adjunct to ablation therapy in eyes with exudative Coats' disease[J]. Clin Ophthalmol, 2021, 15: 367-373. DOI: 10.2147/OPTH.S293030.
6. Jiang L, Qin B, Luo XL, et al. Three-year follow-up of Coats disease treated with conbercept and 532-nm laser photocoagulation[J]. World J Clin Cases, 2020, 8(24): 6243-6251. DOI: 10.12998/wjcc.v8.i24.6243.
7. Zhang L, Ke Y, Wang W, et al. The efficacy of conbercept or ranibizumab intravitreal injection combined with laser therapy for Coats' disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(7): 1339-1346. DOI: 10.1007/s00417-018-3949-1.
8. Shields JA, Shields CL, Honavar SG, et al. Clinical variations and complications of Coats disease in 150 cases: the 2000 Sanford Gifford Memorial Lecture[J]. Am J Ophthalmol, 2001, 131(5): 561-571. DOI: 10.1016/s0002-9394(00)00883-7.
9. Schulze-Bonsel K, Feltgen N, Burau H, et al. Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test[J]. Invest Ophthalmol Vis Sci, 2006, 47(3): 1236-1240. DOI: 10.1167/iovs.05-0981.
10. 中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Fundus Disease Group of Ophthalmology Branch of Chinese Medical Association. Quality control standard for intravitreal injection of retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
11. 何晶晶, 孙祖华, 刘晓玲. 局部视网膜激光光凝治疗Coats病的疗效观察[J]. 中华眼底病杂志, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.He JJ, Sun ZH, Liu XL. Efficacy of focal photocoagulation on Coats disease[J]. Chin J Ocul Fundus Dis, 2021, 37(8): 605-609. DOI: 10.3760/cma.j.cn511434-20201010-00487.
12. Toi M, Matsumoto T, Bando H. Vascular endothelial growth factor: its prognostic, predictive, and therapeutic implications[J]. Lancet Oncol, 2001, 2(11): 667-673. DOI: 10.1016/S1470-2045(01)00556-3.
13. Mano F, Matsushita I, Kondo H, et al. Vitrectomy and external drainage of subretinal fluid containing high concentration of vascular endothelial growth factor for advanced coats disease[J/OL]. Sci Rep, 2021, 11(1): 19333[2021-09-29]. https://pubmed.ncbi.nlm.nih.gov/34588604/. DOI: 10.1038/s41598-021-98968-9.
14. Kase S, Rao NA, Yoshikawa H, et al. Expression of vascular endothelial growth factor in eyes with Coats' disease[J]. Invest Ophthalmol Vis Sci, 2013, 54(1): 57-62. DOI: 10.1167/iovs.12-10613.
15. Liang T, Xu Y, Zhu X, et al. Aqueous humour cytokines profiles in eyes with Coats disease and the association with the severity of the disease[J]. BMC Ophthalmol, 2020, 20(1): 178. DOI: 10.1186/s12886-020-01421-0.
16. Stanga PE, Jaberansari H, Bindra MS, et al. Transcleral drainage of subretinal fluid, anti-vascular endothelial growth factor, and wide-field imaging-guided laser in Coats exudative retinal detachment[J]. Retina, 2016, 36(1): 156-162. DOI: 10.1097/IAE.0000000000000669.
17. Kang HG, Kim JD, Choi EY, et al. Clinical features and prognostic factors in 71 eyes over 20 years from patients with Coats' disease in Korea[J/OL]. Sci Rep, 2021, 11(1): 6124[2021-03-17]. https://pubmed.ncbi.nlm.nih.gov/33731773/. DOI: 10.1038/s41598-021-85739-9.
18. Li H, Lei N, Zhang M, et al. Pharmacokinetics of a long-lasting anti-VEGF fusion protein in rabbit[J]. Exp Eye Res, 2012, 97(1): 154-159. DOI: 10.1016/j.exer.2011.09.002.
19. Van Bergen T, Etienne I, Cunningham F, et al. The role of placental growth factor (PIGF) and its receptor system in retinal vascular diseases[J]. Prog Retin Eye Res, 2019, 69: 116-136. DOI: 10.1016/j.preteyeres.2018.10.006.
20. Chiu HH, Wan MJ, Kertes PJ, et al. Visual outcomes after treatment in pediatric patients with Coats' disease[J]. Can J Ophthalmol, 2019, 54(6): 647-652. DOI: 10.1016/j.jcjo.2019.02.004.
21. Liang T, Peng J, Zhang Q, et al. Management of stage 3B Coats disease: presentation of a combined treatment modality and long-term follow-up[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(9): 2031-2038. DOI: 10.1007/s00417-020-04739-z.
22. Ramasubramanian A, Shields CL. Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction[J]. Br J Ophthalmol, 2012, 96(3): 356-359. DOI: 10.1136/bjophthalmol-2011-300141.
23. Gaillard MC, Mataftsi A, Balmer A, et al. Ranibizumab in the management of advanced Coats disease stages 3B and 4: long-term outcomes[J]. Retina, 2014, 34(11): 2275-2281. DOI: 10.1097/IAE.0000000000000248.
24. Daruich A, Matet A, Tran HV, et al. Extramacular fibrosis in Coats' disease[J]. Retina, 2016, 36(10): 2022-2028. DOI: 10.1097/IAE.0000000000001013.
25. Zheng XX, Jiang YR. The effect of intravitreal bevacizumab injection as the initial treatment for Coats' disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(1): 35-42. DOI: 10.1007/s00417-013-2409-1.
26. Bergstrom CS, Hubbard GB 3rd. Combination intravitreal triamcinolone injection and cryotherapy for exudative retinal detachments in severe Coats disease[J]. Retina, 2008, 28(Suppl 3): S33-37. DOI: 10.1097/IAE.0b013e318159ecad.

Chinese Journal of Ocular Fundus Diseases

Long-term outcomes of adjuvant intravitreal injection of conbercept therapy in juvenile Coats disease

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