SUBFOVEAL NODULE IN COATS' DISEASE: Toward an Updated Classification Predicting Visual Prognosis.

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Version: Final published version
Serval ID
serval:BIB_A4A47A3A47E0
Type
Article: article from journal or magazin.
Collection
Publications
Title
SUBFOVEAL NODULE IN COATS' DISEASE: Toward an Updated Classification Predicting Visual Prognosis.
Journal
Retina
Author(s)
Daruich A.L., Moulin A.P., Tran H.V., Matet A., Munier F.L.
ISSN
1539-2864 (Electronic)
ISSN-L
0275-004X
Publication state
Published
Issued date
08/2017
Peer-reviewed
Oui
Volume
37
Number
8
Pages
1591-1598
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
To determine the prevalence, clinical characteristics and nature of subfoveal nodules in Coats' disease and the associated impact on the long-term visual outcome.
Consecutive cases of Coats' disease with foveal exudation were retrospectively reviewed. The presence of a subfoveal nodule or macular fibrosis was recorded. Clinical characteristics, retinal imaging, and outcome were analyzed by comparative analysis. The histopathological description of an enucleated eye with subfoveal nodule was performed.
Among 40 patients presenting unilateral Stage 2B or 3A1 Coats' disease, a subfoveal nodule was detected in 21 patients (52.5%). The median follow-up was 4.7 years. Nineteen patients (47.5%) did not present a subfoveal nodule. Three patients (15.8%) without subfoveal nodule and 21 patients (100%) with subfoveal nodule progressed to a macular fibrotic scar (P < 0.0001), and the mean time of macular fibrosis onset was 11.0 ± 2.6 months. Final visual acuity was significantly worse in patients who presented a subfoveal nodule at diagnosis (P = 0.01). Of 18 cases with subfoveal nodule who underwent fluorescein angiography, retinal-retinal anastomosis and neovascularization were detected in 13 (72.2%) and 2 eyes (11.1%), respectively. Histopathological analysis of a subfoveal nodule revealed an aggregate of proteinaceous material including fibrin, spindle cells, macrophages, and pigmented cells.
The presence of a subfoveal nodule at presentation is a predictive factor for macular fibrosis development and worse visual outcome in patients with Coats' disease. These observations suggest an updated classification introducing two subcategories within Stage 2B: without subfoveal nodule (Stage 2B1) and with subfoveal nodule (Stage 2B2).

Keywords
Child, Preschool, Female, Fibrosis/diagnosis, Fibrosis/etiology, Fluorescein Angiography/methods, Follow-Up Studies, Fovea Centralis/pathology, Fundus Oculi, Humans, Macula Lutea/pathology, Male, Prognosis, Retinal Telangiectasis/classification, Retinal Telangiectasis/complications, Retinal Telangiectasis/diagnosis, Retrospective Studies, Time Factors, Visual Acuity
Pubmed
Web of science
Create date
03/01/2017 17:57
Last modification date
20/08/2019 15:10
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