Adult-onset Coats’ disease. Case series and literature review Case series report
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Published:
Mar 16, 2026
Keywords:
Coats' disease, adult-onset, retinal telangiectasia, retinal vasculopathy, multimodal treatment
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Abstract
Adult-onset Coats’ disease is a rare idiopathic retinal vascular disorder. We present three cases of unilateral retinal telangiectasia and exudation diagnosed through clinical examination and fluorescein angiography. All patients were treated with laser photocoagulation and/or: two also underwent cryotherapy, one received transpupillary thermotherapy, and two received adjunctive anti-VEGF therapy. A literature review highlights male predominance, variable age of onset, and frequent macular involvement. Initial vision acuity appears to be the primary predictor of post-treatment outcomes. Early diagnosis and combined therapy can stabilise the disease and preserve vision.
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1.
Horwat P, Zwolińska E, Rospond-Kubiak I. Adult-onset Coats’ disease. Case series and literature review. Ophthatherapy [Internet]. 2026Mar.16 [cited 2026May30];12(4). Available from: https://www.journalsmededu.pl/index.php/ophthatherapy/article/view/3303
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Diagnostics
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Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
1. Coats G. Forms of retinal disease with massive exudation. J. & A. Churchill, London 1908.
2. Kanski JJ, Salmon JF. Kanski’s Clinical Ophthalmology : a Systematic Approach. Ninth edition. 9th ed. Elsevier, 2020.
3. Stephen M, Temkar S, Periyandavan J et al. A Brief Review on Adult-Onset Coats’ Disease. Romanian J Ophthalmol. 2024; 68: 212–8. https://doi.org/10.22336/rjo.2024.40.
4. Shields JA, Shields CL, Honavar SG et al. Clinical variations and complications of Coats disease in 150 cases: the 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001; 131: 561-71. https://doi.org/10.1016/S0002-9394(00)00883-7.
5. Rishi E, Rishi P, Appukuttan B et al. Coats’ disease of adult-onset in 48 eyes. Indian J Ophthalmol. 2016; 64(7): 518-23. https://doi.org/10.4103/0301-4738.190141.
6. Gawęcki M. Idiopathic Peripheral Retinal Telangiectasia in Adults: A Case Series and Literature Review. J Clin Med. 2021; 10: 1767. https://doi.org/10.3390/jcm10081767.
7. American Academy of Ophthalmology. Basic Clinical and Science Course, Section 12, Retina and Vitreous. 2023.
8. Amoroso F, Miere A, Colantuono D et al. Navigated Focal Laser of Macular Telangiectasia Type I (Adult-Onset Coats’ Disease). Ophthalmic Surg Lasers Imaging Retina. 2024; 55: 545-51. https://doi.org/10.3928/23258160-20240412-02.
9. Hansraj S, Raval V, Jalali S et al. Clinical Presentation and Treatment Outcomes of Adult-Onset Coats Disease. J Vitreoretin Dis. 2025; 9: 43-9. https://doi.org/10.1177/24741264241286580.
10. Jung S, Woo SJ. Ultra-Widefield Fluorescein Angiographic Features Influencing Visual Prognosis in Coats Disease. Korean J Ophthalmol. 2024; 38: 413-23. https://doi.org/10.3341/kjo.2024.0100.
11. Zhou W, Zhou H, Liu Y-Y et al. Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease. Int J Ophthalmol. 2024; 17: 1469-76. https://doi.org/10.18240/ijo.2024.08.12.
12. Wang K-Y, Cheng C-K. A combination of intravitreal bevacizumab injection with tunable argon yellow laser photocoagulation as a treatment for adult-onset Coats’ disease. J Ocul Pharmacol Ther. 2011; 27: 525-30. https://doi.org/10.1089/jop.2011.0088.
13. Otani T, Yasuda K, Aizawa N et al. Over 10 years follow-up of Coats’ disease in adulthood. Clin Ophthalmol Auckl NZ. 2011; 5: 1729-32. https://doi.org/10.2147/OPTH.S27938.
14. Shields C, Udyaver S, Dalvin L et al. Coats disease in 351 eyes: Analysis of features and outcomes over 45 years (by decade) at a single center. Indian J Ophthalmol. 2019; 67: 772. https://doi.org/10.4103/ijo.IJO_449_19.
15. Sen M, Shields C, Honavar S et al. Coats disease: An overview of classification, management and outcomes. Indian J Ophthalmol 2019; 67: 763. https://doi.org/10.4103/ijo.IJO_841_19.
16. Banerjee M, Nayak S, Kumar S et al. Adult-onset Coats disease. Surv Ophthalmol. 2023; 68: 591-600. https://doi.org/10.1016/j.survophthal.2023.03.002.
17. Yang X, Wang C, Su G. Recent advances in the diagnosis and treatment of Coats’ disease. Int Ophthalmol. 2019; 39: 957-70. https://doi.org/10.1007/s10792-019-01095-8.
18. 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. Sci Rep. 2021; 11: 6124. https://doi.org/10.1038/s41598-021-85739-9.
19. Zheng X-X, Jiang Y-R. The effect of intravitreal bevacizumab injection as the initial treatment for Coats’ disease. Graefes Arch Clin Exp Ophthalmol. 2014; 252: 35-42. https://doi.org/10.1007/s00417-013-2409-1.
20. Zhang L, Ke Y, Wang W et al. The efficacy of conbercept or ranibizumab intravitreal injection combined with laser therapy for Coats’ disease. Graefes Arch Clin Exp Ophthalmol. 2018; 256: 1339-46. https://doi.org/10.1007/s00417-018-3949-1.
21. Xu X, Essilfie J, Gong Y et al. Resolution of Foveal Lipid Deposition in Adult-Onset Coats Disease With Combined Focal Laser Photocoagulation and Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina. 2021; 52: 396-9. https://doi.org/10.3928/23258160-20210628-07.
22. Kumar V, Chandra P, Kumar A. Ultra-wide field imaging in the diagnosis and management of adult-onset Coats’ disease. Clin Exp Optom. 2017; 100(1): 79-82. https://doi.org/10.1111/cxo.12418.
23. Dave AD, Thavikulwat AT, De Silva T et al. Longitudinal characterization and treatment response of retinal arterial macroaneurysms in adult-onset coats disease. Am J Ophthalmol Case Rep. 2022; 27: 101647. https://doi.org/10.1016/j.ajoc.2022.101647.
24. Wang Y, Fan H, Gao K et al. Levels of cytokines in the aqueous humor guided treatment of refractory macular edema in adult-onset Coats’ disease. BMC Ophthalmol. 2020; 20: 261. https://doi.org/10.1186/s12886-020-01474-1.
25. Goel N, Kumar V, Seth A et al. Role of intravitreal bevacizumab in adult onset Coats’ disease. Int Ophthalmol. 2011; 31: 183-90. https://doi.org/10.1007/s10792-011-9436-x .
2. Kanski JJ, Salmon JF. Kanski’s Clinical Ophthalmology : a Systematic Approach. Ninth edition. 9th ed. Elsevier, 2020.
3. Stephen M, Temkar S, Periyandavan J et al. A Brief Review on Adult-Onset Coats’ Disease. Romanian J Ophthalmol. 2024; 68: 212–8. https://doi.org/10.22336/rjo.2024.40.
4. Shields JA, Shields CL, Honavar SG et al. Clinical variations and complications of Coats disease in 150 cases: the 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001; 131: 561-71. https://doi.org/10.1016/S0002-9394(00)00883-7.
5. Rishi E, Rishi P, Appukuttan B et al. Coats’ disease of adult-onset in 48 eyes. Indian J Ophthalmol. 2016; 64(7): 518-23. https://doi.org/10.4103/0301-4738.190141.
6. Gawęcki M. Idiopathic Peripheral Retinal Telangiectasia in Adults: A Case Series and Literature Review. J Clin Med. 2021; 10: 1767. https://doi.org/10.3390/jcm10081767.
7. American Academy of Ophthalmology. Basic Clinical and Science Course, Section 12, Retina and Vitreous. 2023.
8. Amoroso F, Miere A, Colantuono D et al. Navigated Focal Laser of Macular Telangiectasia Type I (Adult-Onset Coats’ Disease). Ophthalmic Surg Lasers Imaging Retina. 2024; 55: 545-51. https://doi.org/10.3928/23258160-20240412-02.
9. Hansraj S, Raval V, Jalali S et al. Clinical Presentation and Treatment Outcomes of Adult-Onset Coats Disease. J Vitreoretin Dis. 2025; 9: 43-9. https://doi.org/10.1177/24741264241286580.
10. Jung S, Woo SJ. Ultra-Widefield Fluorescein Angiographic Features Influencing Visual Prognosis in Coats Disease. Korean J Ophthalmol. 2024; 38: 413-23. https://doi.org/10.3341/kjo.2024.0100.
11. Zhou W, Zhou H, Liu Y-Y et al. Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease. Int J Ophthalmol. 2024; 17: 1469-76. https://doi.org/10.18240/ijo.2024.08.12.
12. Wang K-Y, Cheng C-K. A combination of intravitreal bevacizumab injection with tunable argon yellow laser photocoagulation as a treatment for adult-onset Coats’ disease. J Ocul Pharmacol Ther. 2011; 27: 525-30. https://doi.org/10.1089/jop.2011.0088.
13. Otani T, Yasuda K, Aizawa N et al. Over 10 years follow-up of Coats’ disease in adulthood. Clin Ophthalmol Auckl NZ. 2011; 5: 1729-32. https://doi.org/10.2147/OPTH.S27938.
14. Shields C, Udyaver S, Dalvin L et al. Coats disease in 351 eyes: Analysis of features and outcomes over 45 years (by decade) at a single center. Indian J Ophthalmol. 2019; 67: 772. https://doi.org/10.4103/ijo.IJO_449_19.
15. Sen M, Shields C, Honavar S et al. Coats disease: An overview of classification, management and outcomes. Indian J Ophthalmol 2019; 67: 763. https://doi.org/10.4103/ijo.IJO_841_19.
16. Banerjee M, Nayak S, Kumar S et al. Adult-onset Coats disease. Surv Ophthalmol. 2023; 68: 591-600. https://doi.org/10.1016/j.survophthal.2023.03.002.
17. Yang X, Wang C, Su G. Recent advances in the diagnosis and treatment of Coats’ disease. Int Ophthalmol. 2019; 39: 957-70. https://doi.org/10.1007/s10792-019-01095-8.
18. 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. Sci Rep. 2021; 11: 6124. https://doi.org/10.1038/s41598-021-85739-9.
19. Zheng X-X, Jiang Y-R. The effect of intravitreal bevacizumab injection as the initial treatment for Coats’ disease. Graefes Arch Clin Exp Ophthalmol. 2014; 252: 35-42. https://doi.org/10.1007/s00417-013-2409-1.
20. Zhang L, Ke Y, Wang W et al. The efficacy of conbercept or ranibizumab intravitreal injection combined with laser therapy for Coats’ disease. Graefes Arch Clin Exp Ophthalmol. 2018; 256: 1339-46. https://doi.org/10.1007/s00417-018-3949-1.
21. Xu X, Essilfie J, Gong Y et al. Resolution of Foveal Lipid Deposition in Adult-Onset Coats Disease With Combined Focal Laser Photocoagulation and Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina. 2021; 52: 396-9. https://doi.org/10.3928/23258160-20210628-07.
22. Kumar V, Chandra P, Kumar A. Ultra-wide field imaging in the diagnosis and management of adult-onset Coats’ disease. Clin Exp Optom. 2017; 100(1): 79-82. https://doi.org/10.1111/cxo.12418.
23. Dave AD, Thavikulwat AT, De Silva T et al. Longitudinal characterization and treatment response of retinal arterial macroaneurysms in adult-onset coats disease. Am J Ophthalmol Case Rep. 2022; 27: 101647. https://doi.org/10.1016/j.ajoc.2022.101647.
24. Wang Y, Fan H, Gao K et al. Levels of cytokines in the aqueous humor guided treatment of refractory macular edema in adult-onset Coats’ disease. BMC Ophthalmol. 2020; 20: 261. https://doi.org/10.1186/s12886-020-01474-1.
25. Goel N, Kumar V, Seth A et al. Role of intravitreal bevacizumab in adult onset Coats’ disease. Int Ophthalmol. 2011; 31: 183-90. https://doi.org/10.1007/s10792-011-9436-x .