Three-Year Results of Management of Adult-Onset Coats' Disease by Possibly Targeting Placental Growth Factor

We report long-term results of treatment with intravitreal injection of aflibercept in a newly diagnosed case of adult-onset Coats' disease. A 40-year-old Philipino male was referred to our Eye Center complaining of vision reduction for the past three months in his right eye. Examination revealed visual acuity of 0.1 in the affected right eye with normal vision of 1.0 in his left eye. Fundal examination of the right eye showed temporal retinal telangiectasia with massive exudation reaching the macula. The left fundal examination was normal. The patient’s optical coherence tomography (OCT) demonstrated massive exudative thickening. The patient was managed with one intravitreal injection of aflibercept followed by focal laser, with successful anatomical and subjective outcomes that were maintained after three years. Aflibercept's profile targeting both vascular endothelial growth factor (VEGF) and placental growth factor seems to show favorable outcomes when compared to other purely anti-VEGF treatment options. We therefore believe that aflibercept is an excellent adjunctive therapy in cases of adult-onset Coats’ disease with macular edema. To our knowledge, this is the first case treated with laser and intravitreal aflibercept with a long three-year follow-up suggesting the significant role of aflibercept in vascular permeability and supporting its use as a valuable therapeutic option for Coats’ disease.