Anti-VEGF and laser therapy stabilize vision in 57.1% of Coats disease eyesCoats Disease Treatments Show Mixed Results in Review

Acta ophthalmologica Published November 6, 2026 Study authors: Francisco Catarina, Silva Nisa, Boon Camiel J F PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Consider anti-VEGF and laser for Coats disease, but note limited safety data and heterogeneous evidence.

This systematic review and meta-analysis examined treatment outcomes for Coats disease in patients aged 18 years or older, focusing on laser photocoagulation and anti-vascular endothelial growth factor (VEGF) agents. The analysis included 240 patients (250 eyes) with confirmed Coats disease.

Anatomical stabilization or regression of exudation was reported in approximately half of treated eyes. Visual acuity stabilized or improved in 57.1% of treated eyes, while recurrence occurred in 19.3%. Effect sizes, absolute numbers, and p-values or confidence intervals were not reported for these outcomes.

The authors note that the included studies were heterogeneous. Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported. Follow-up duration and study setting were also not reported.

The authors suggest that therapeutic outcomes appear to favor individualized, imaging-guided combination strategies. However, the heterogeneity of the included studies and the lack of reported safety data limit the certainty of these findings. Clinicians should interpret these results with caution given the observational nature of the synthesized evidence and the absence of comparative data.

How this fits prior evidence

This meta-analysis extends prior coverage of anti-VEGF safety, which noted that bleeding risk remains poorly characterized in cancer patients receiving concurrent anti-VEGF and anticoagulant therapy. The current review focuses on anti-VEGF use in Coats disease and does not report adverse events, leaving safety questions unaddressed. It provides outcome estimates for anatomical stabilization and visual acuity but does not clarify comparative effectiveness or long-term recurrence risk. The findings are consistent with the need for individualized, imaging-guided strategies, but heterogeneity across studies limits direct comparison with prior evidence.

A new review pooled data from studies of adults with Coats disease, a rare eye condition that causes leaking blood vessels in the retina. The analysis included 240 patients and 250 eyes. It looked at two treatments: laser photocoagulation and anti-VEGF drugs, which are injected to slow vessel growth.

The results were mixed. The researchers report that signs of leakage stabilized or improved in about half of treated eyes. Vision stayed the same or got better in 57.1% of treated eyes. The condition came back in 19.3% of treated eyes.

The review did not report safety information, such as side effects or serious problems. That is a real gap, since any treatment decision should weigh benefits against risks.

The main caution is that the studies combined in this review were quite different from one another. That makes it hard to draw firm conclusions about which treatment works best or for whom. The authors suggest that care tailored to each patient's imaging results, often using more than one treatment, may be the most promising approach. Readers should treat these numbers as a general picture, not a promise of what will happen in any single case.

What this means for you:

In adults with Coats disease, about half of treated eyes improved structurally and 57% kept or gained vision, but studies varied.

Common questions

What is Coats disease?

Coats disease is a rare eye condition in which blood vessels in the retina leak fluid. This review focused on adults aged 18 and older with confirmed Coats disease. It is different from many eye conditions because it can cause vision loss from fluid buildup. Ask your eye doctor for details about your specific case.

How well did the treatments work in this review?

The review included 250 eyes. Signs of leakage stabilized or improved in about half of treated eyes. Vision stayed the same or got better in 57.1% of treated eyes. The condition came back in 19.3% of treated eyes. These are pooled results, so individual outcomes can differ.

Were side effects reported?

No. The review did not report side effects, serious problems, or how well patients tolerated treatment. That means this analysis cannot tell you about the risks of laser treatment or anti-VEGF injections. If you are considering treatment, ask your doctor about possible side effects and what they mean for you.

Why should I be cautious about these results?

The studies combined in this review were quite different from one another, which makes it hard to compare treatments or predict individual outcomes. The review also did not report a single main outcome or follow-up length. The authors suggest that care guided by each patient's imaging, often combining treatments, may be most promising.

Study Details

Study typeMeta analysis

Sample sizen = 240

EvidenceLevel 1

PublishedNov 2026

PMID42047283

View Original Abstract ↓

Coats disease diagnosed in adulthood is a rare idiopathic retinal telangiectatic vasculopathy that may differ in phenotype from childhood-diagnosed cases. This systematic review synthesizes current evidence to characterize its clinical spectrum, imaging features, treatment outcomes and underlying mechanisms, with a focus on immunovascular pathways. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, PubMed, Scopus and Web of Science were searched through October 2025 for studies including patients ≥18 years with confirmed Coats disease. Clinical and imaging findings, treatment strategies and outcomes were extracted and narratively synthesized. When possible, random-effects meta-analysis was performed. Thirty-five studies comprising 240 patients (250 eyes) were included. Disease presentation was predominantly unilateral and diagnosed at Shields Stage 2 or 3. Laser photocoagulation and anti-vascular endothelial growth factor (VEGF) agents were the most frequently described therapies, with anatomical stabilization or regression of exudation reported in approximately half of treated eyes across heterogeneous studies, and better outcomes in earlier stages. Visual acuity was stabilized or improved in 57.1% of treated eyes, while recurrence occurred in 19.3%. Multimodal imaging consistently identified peripheral telangiectasia, lipid exudation and localized capillary nonperfusion. Aqueous cytokine profiling in small cohorts has reported elevated inflammatory mediators (e.g. interleukin [IL]-6 and IL-1β) in some adults, suggesting that inflammatory signalling may contribute to blood-retina barrier dysfunction and macular oedema alongside VEGF-related permeability. Current evidence supports Coats disease diagnosed in adulthood as a chronic telangiectatic retinal vasculopathy with frequent macular involvement. Therapeutic outcomes appear to favour individualized, imaging-guided combination strategies and prospective studies with standardized endpoints are needed to refine management.

Anti-VEGF and laser therapy stabilize vision in 57.1% of Coats disease eyesCoats Disease Treatments Show Mixed Results in Review

How this fits prior evidence

Common questions

Study Details

SGLT2 inhibitors reduce risk of diabetic retinopathy progression (rr 0.77) and macular edema progression (rr 0.75)

SGLT2 inhibitors show promise in slowing diabetic eye disease

Clinical research that matters. Delivered to your inbox.

Anti-VEGF and laser therapy stabilize vision in 57.1% of Coats disease eyesCoats Disease Treatments Show Mixed Results in Review

How this fits prior evidence

Common questions

More on Coats disease

Study Details

SGLT2 inhibitors reduce risk of diabetic retinopathy progression (rr 0.77) and macular edema progression (rr 0.75)

SGLT2 inhibitors show promise in slowing diabetic eye disease

Clinical research that matters. Delivered to your inbox.

Related in Ophthalmology

From Other Specialties