Coats Disease in Young Patient with Congenital Cataracts History

Luis Javier Cárdenas Lamas1*, Marisol Iñiguez Soto2, Lidia Griselda Álvarez Rivera3, Sandra Elizabeth Partida Calderón4, Luis Humberto Sepúlveda Tinajero5 and Jennifer Gabriela Martínez Ríos6 1Assigned Doctor and responsible of the Pediatric Ophthalmology and Strabismus Department of the High Speciality Ophthalmology Unit at Hospital Civil de Guadalajara Fray Antonio Alcalde, México 2Assigned Doctor and responsible of the Orbit, Eyelids and Lacrimal Ducts of the High Specialty Ophthalmology Unit at Hospital Civil de Guadalajara Fray Antonio Alcalde, Mexico 3Assigned Doctor to the Medical and Surgical Retinal Service of the High Specialty Ophthalmology Unit at Hospital Civil de Guadalajara Fray Antonio Alcalde, Mexico 4Ophthalmology Surgeon with High Specialty in Strabismus and Pediatric Ophthalmology, Mexico 5Ophthalmology Surgeon in his second year Fellowship in Medical and Surgical Retina of the High Specialty Ophthalmology at Hospital Civil de Guadalajara Fray Antonio Alcalde, Mexico 6Resident Ophthalmology Doctor in her second year of the High Specialty Ophthalmology Unit at Hospital Civil de Guadalajara Fran Antonio Alcalde, Mexico

Coats disease is a retinal vascular pathology that presents telangiectasias and idiopathic vascular leaks, with microvascular changes that are accompanied by intraretinal and / or subretinal exudation, which in advanced cases can progress to neovascular glaucoma and total retinal detachment, leading to an irreversible visual loss, it is an idiopathic disorder which does not usually comes with any systemic association. Coats disease has a great diversity in terms of its clinical presentation. The treatment of this disease varies according to the stage of presentation, the most widely used therapy being retinal laser photocoagulation and recently the intravitreal injection of vascular endothelial growth factor (anti-VEGF) inhibitors [1]. We present a young male with Coats disease and a history of congenital cataract in both eyes.

Case Report
He is 14-year-old boy, attended at the Ophthalmology Unit

Discussion
Coats Disease is a retinal vascular disease, characterized by telangiectasias and vascular leaks that lead to exudation. It is typically found in young males, between the first and second decade of life, with a peak of incidence between 5 and 11 years old. In 85-90% of patients, it is a unilateral affectation. In cases of bilateral disease, the other eye shows no symptoms with slight telangiectasic changes in the periphery. There is no preference for race, and is a sporadic non inherited condition, without systemic association; the gold standard for the diagnosis of this disease is the eye fundus clinical exploration through direct ophthalmoscopy [1,2] and as our patient fitted in the above-mentioned characteristics, the diagnosis of Coats has reached. However, there are very few reports regarding the association of this pathology with the presentation of Congenital cataracts, even less in a bilateral way, as is the case of our patient [3,4]. However, the innovative therapy is the use of intra vitreous VEGF, which is also recommended as a contributory manner with the traditional therapies already mentioned, since it seems to reduce macular edema and exudates, stabilize visual acuity and enhance regression of abnormal vessels, as observed in our patient, with a vision improvement and reduction of posterior retinal exudation to the first dose of intra vitreous anti-VEGF. Even though a complete regression of the disease is not expected, our objective is to stop progression and avoid appearance of future complications. [2,6,7].
Even though association of the appearance of cataracts is reported, after presentation of Coats disease, as mentioned by Daruich A. et al. [7], inverse association (that means, late presentation of Coats disease with bilateral congenic cataracts background) without a syndromic association is very rare.

Conclusion
Coats disease is a pathology that must be found within the diagnostic suspicion from the general ophthalmologist and the pediatric ophthalmologist since it is a relatively frequent pathology, since it can have important implications for the visual quality and life of the patient; as well as the severity of differential possible diagnosis as can be the retinoblastoma and, as in our case, always maintain close ophthalmologic monitoring in patients with pathologies that are not so frequently associated as Congenital cataracts, since, as there are no systemic associations found, the current limited understanding of the exact pathophysiological mechanisms that produce this disease leaves us with a window of possibilities in which we can observe clinical presentations as varied as the case of our patient.