Background: The exact pathogenetic mechanisms of Coats� disease remain unknown. In this report, we show two\ncases of Coats� disease that achieved a favorable prognosis with the combined treatment of intravitreal\nbevacizumab (IVB) injection prior to photocoagulation, although both initially resisted photocoagulation therapy.\nCase presentations: Case 1 was a 15-year-old boy with initial visual acuity of 0.4 OD. At the temporal retina,\naneurysms and abnormal telangiectatic vessels were observed. Hard exudates and an exudative retinal detachment\nextended to the fovea. He was diagnosed as having Coats� disease at stage 3A and we performed laser\nphotocoagulation as an initial approach to treat peripheral aneurysms and telangiectatic vessels. After the\ntreatment, the exudative retinal detachment was eased and visual acuity improved to 1.0; however, recurrence\noccurred after 5 months. The exudative change was resistant against laser photocoagulation therapy and we\ntherefore added IVB as an adjuvant before photocoagulation. Fourteen days after IVB injection phased laser\nphotocoagulation was given to cover the abnormal capillaries, aneurysms and the leakage area spotted in FA.\nA good prognosis was obtained with decreased exudation and improved visual acuity.\nCase 2 was an 11-year-old boy with decreased visual acuity of 0.15 OS at the initial visit. Hard exudates, retinal\nedema and serous retinal detachment were seen at the macula and peripheral retina. Fluorescein angiography\nrevealed telangiectatic capillaries at the temporal retina. Our diagnosis was Coats� disease at stage 3A. Extensive\nphotocoagulation was performed as an initial treatment to the lesion. However, the exudative change was\nsevere and resistant against the photocoagulation treatment. Therefore, we added IVB as an adjuvant before\nphotocoagulation. Exudative change in the retina seemed to be eased 7 days after IVB injection, therefore, phased\nlaser phototherapy was added to cover the abnormal capillaries. After the combination therapy, exudative change\nwas remarkably ameliorated and better visual acuity was achieved.\nConclusion: Bevacizumab is considered an effective adjuvant for Coats� disease with exudative change resistant to\nretinal photocoagulation therapy.
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