Adult-Onset Coats Disease in a 61-Year-Old Woman: A Case Report

Adult-Onset Coats Disease in a 61-Year-Old Woman: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Adult-Onset Coats Disease in a 61-Year-Old Woman: A Case Report Ribo Peng, Yi Zhu, xiaoshuang Tang, Xiaochun Yang, Na Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8668170/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Coats disease is a rare congenital retinopathy characterized by retinal telangiectasia and exudation, typically affecting young males. Adult-onset cases are uncommon and often present with milder manifestations. Case presentation: A 61-year-old woman presented with a 3-month history of vision loss in her right eye, worsening over 6 days. Examination revealed right-eye visual acuity of 20/40, retinal vessel dilatation, yellowish-white exudation, and shallow retinal detachment in the temporal periphery. Fundus photography, fluorescein angiography, optical coherence tomography (OCT), ultrasound, and magnetic resonance imaging (MRI) confirmed stage 3A Coats disease and bilateral age-related cataracts. Treatment included argon laser photocoagulation and periocular triamcinolone acetonide, followed by intravitreal conbercept injection. Follow-up at 6 months showed reduced exudation, partial retinal reattachment, and improved visual acuity to 20/60, though macular edema persisted. Conclusion Adult-onset Coats disease can present with significant retinal exudation but a favorable prognosis with early intervention. Combined laser and anti-vascular endothelial growth factor (VEGF) therapy may improve outcomes. Adult Coats conbercept retinal photocoagulation triamcinolone acetonide Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Coats disease, first described in 1908, is a congenital retinopathy characterized by retinal telangiectasia, lipid exudation, and progression to exudative retinal detachment[ 1 ]. Although its etiology remains unclear, it may involve inflammation, metabolic disorders, or genetic mutations[ 2 ]. Pathologically, retinal vessel abnormalities, including arteriolar and capillary dilatation and vessel wall thickening, lead to blood-retinal barrier breakdown, causing retinal swelling and detachment[ 3 , 4 ]. While typically affecting young boys, adult-onset Coats disease is rare, often presenting with limited retinal involvement, less hemorrhage, and better visual prognosis[ 5 , 6 ]. This report describes the clinical features, diagnosis, and management of stage 3A Coats disease in a 61-year-old woman, highlighting the role of combined laser and anti-VEGF therapy. Case presentation A 61-year-old woman presented to the Ophthalmology Department of Chongqing University Three Gorges Hospital on October 14, 2020, with a 3-month history of vision loss in her right eye, worsening over 6 days. She denied systemic conditions (e.g., diabetes, hypertension, hypercholesterolemia), infectious diseases, trauma, or surgery. Her personal, marital, obstetric, and family histories were unremarkable. On examination, her best-corrected visual acuity was 20/400 OD and 20/25. Pupils were reactive with no relative afferent pupillary defect, and intraocular pressure measurements were unremarkable, as were the results of the external examinations. Both eyes showed mild lens opacities, with normal anterior segments. Dilated fundus examination of the right fundus exhibited clear optic disc borders (cup-to-disc ratio: 0.3), retinal vessel dilatation, mild bluish-gray elevation, and massive yellowish-white exudation in the temporal periphery and shallow retinal detachment (Fig. 1 ). Results of a dilated fundus examination of the left eye were unremarkable. Fundus fluorescein angiography (FFA) demonstrated abnormal vessel dilatation and terminal fluorescein leakage (Fig. 2 ). Optical coherence tomography (OCT) of the right eye (Fig. 3 ) revealed temporal neuroepithelial and pigment epithelial detachment (Fig. 3 ). Ocular ultrasound detected a hyperechoic band-like lesion and retinal detachment (Fig. 4 ). Magnetic resonance imaging of the orbit revealed right temporal retinal thickening with protrusion into the vitreous cavity, hyperintense on T1- and T2-weighted imaging (Fig. 5 ). Results were unremarkable in the left eye. The diagnosis was stage 3A Coats disease in the right eye and bilateral age-related cataracts. Informed consent was obtained for treatment and publication. Argon laser photocoagulation was performed on the temporal superior exudative lesion and peripheral detachment area (spot size: 200–300 µm, energy: 150–170 J, exposure: 0.2 s). However, laser treatment was less effective in the detachment area. A periocular injection of triamcinolone acetonide (20 mg) was administered. At follow-up on April 6, 2021, Visual acuity was improved to 20/60 OD, with reduced exudation and detachment; laser spots were visible. However, OCT showed worsened macular cystoid edema (Fig. 6 ). The patient declined intravitreal triamcinolone due to concerns about steroid-induced glaucoma and opted for intravitreal conbercept (0.05 mL, 0.5 mg) injected 4 mm posterior to the limbus. Discussion and conclusions Coats disease, characterized by retinal telangiectasia and exudation, results from vascular abnormalities resembling diabetic retinopathy, including pericyte loss and microaneurysm formation[ 7 ]. The breakdown of the blood-retinal barrier allows lipid-rich exudation into the retina and subretinal space, causing swelling and detachment[ 8 ]. Adult-onset Coats disease, as seen in this case, is rare, with reported onset ages ranging from 22 to 62 years. Unlike pediatric cases, adult-onset disease typically involves smaller lesions, less macular damage, and slower progression, often yielding better visual outcomes[ 6 ]. Diagnostic imaging is critical. Fundus photography and FFA confirm exudation and vascular abnormalities, while OCT and ultrasound assess macular edema and detachment severity[ 9 ]. MRI in this case showed hyperintense signals, consistent with high-protein exudation[ 10 ]. Shields et al. classify Coats disease into five stages, with stage 3A indicating exudation and partial detachment, as observed here[ 7 , 11 ]. Treatment aims to eliminate abnormal vessels and exudation. Laser photocoagulation, used in this case, is effective for mild cases, closing abnormal vessels and reducing exudation[ 12 ]. Periocular triamcinolone promotes fluid absorption but carries risks of glaucoma[ 13 ]. Anti-VEGF agents, such as conbercept, reduce retinal edema and exudation by targeting elevated intraocular VEGF levels[ 14 ]. In this case, combined laser and conbercept therapy improved visual acuity and reduced detachment, avoiding invasive procedures like vitrectomy. However, persistent macular edema suggests the need for ongoing monitoring. Systemic conditions like hypertension or diabetes, reported in some adult cases, were absent here. Adult-onset Coats disease is a rare but important differential diagnosis for adults presenting with unilateral vision loss and exudative retinopathy. This case demonstrates that a multi-modal approach combining laser photocoagulation with periocular steroids and intravitreal anti-VEGF therapy can lead to favorable anatomical and functional outcomes, effectively managing the disease and avoiding the need for more invasive surgery. Further research is warranted to better understand the pathogenesis and optimize treatment strategies for both adult and juvenile forms of Coats disease. Abbreviations optical coherence tomography OCT ultrasound, and magnetic resonance imaging MRI anti-vascular endothelial growth factor VEGF Fundus fluorescein angiography FFA Declarations Ethics approval and consent to participate This research has been approved by the ethics committee of Chongqing University Three Gorges Hospital .The patients informed consent to participate was obtained in this case report. Consent for publication The patient provided written informed consent for the publication of the clinical data and images contained in this case report. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests Funding None to declare. Authors' contributions The authors confirm their contribution to the paper as follows: Yi Zhu: analyzed and interpreted the patient data. Xiaochun Yang: took and edited the images. Xiaoshuang Tang: patient treatment. Ribo Peng ： writing-original draft. Na Li: Writing-review & editing. All authors read and approved the final version of the manuscript. Acknowledgements Thanks to all the peer reviewers and editors for their opinions and suggestions. References Morales AG. Coats' Disease*. Am J Ophthalmol. 1965;60(5):855–65. Sigler EJ, Randolph JC, Calzada JI, Wilson MW, Haik BG. Current management of Coats disease. Surv Ophthalmol. 2014;59(1):30–46. Ghorbanian S, Jaulim A, Chatziralli IP. Diagnosis and Treatment of Coats’ Disease: A Review of the Literature. Ophthalmologica. 2012;227(4):175–82. Ucgul AY, Özdek Ş. Coats’ Disease: A Comprehensive Review of Its Pathophysiology, Diagnosis, and Advances in Treatment. Semin Ophthalmol. 2024;40(6):458–73. Banerjee M, Nayak S, Kumar S, Bhayana AA, Kumar V. Adult-onset Coats disease. Surv Ophthalmol. 2023;68(4):591–600. Mary Stephen ST, Jayasri, Periyandavan. Kalyan Basa: A Brief Review on Adult-Onset Coats’ Disease. Romanian J Ophthalmol 2024, 68(3). JERRY A. SHIELDS M, SHIELDS CAROLL, MD SONTASHG, HONAVAR, MD, AND, HAKAN DEMIRCI M. Clinical variations and complications of Coats disease in 150cases: the 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001;131(5):561–71. Rishi P, Rishi E, Appukuttan B, Uparkar M, Sharma T, Gopal L. Coats′ disease of adult-onset in 48 eyes. Indian J Ophthalmol 2016, 64(7). Zhou W, Liu Y-Y, Li M-X, Wu X-H, Liang J, Hao J, Liu S-N, Jin C-J. Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease. Int J Ophthalmol. 2024;17(8):1469–76. Guarnera A, Valente P, Pasquini L, Moltoni G, Randisi F, Carducci C, Carboni A, Lucignani G, Napolitano A, Romanzo A, et al. Congenital Malformations of the Eye: A Pictorial Review and Clinico-Radiological Correlations. J Ophthalmol. 2024;2024:1–17. Shanmugam MP, Shah PN, Sagar P, Ramanjulu R, Mishra DK. Coats’ disease – Prognostic factors for globe and vision salvage in children, a long-term experience. Indian J Ophthalmol. 2022;70(2):483–9. Oli A, Balakrishnan D, Jalali S. Coats’ disease: trends and long-term treatment outcomes in a tertiary referral centre. Therapeutic Adv Ophthalmol 2021, 13. Berco E, Elsliger S, Weinberg T, Ghannam W, Shoham-Hazon N. Triple Trouble with Triple Solutions: A Unique Case Report of a Severe Exudative Retinal Detachment Accompanied by Retinal Traction and Two Retinal Holes in Coats Disease. Case Rep Ophthalmol. 2024;15(1):84–91. Jiang L, Qin B, Luo X-L, Cao H, Deng T-M, Yang M-M, Meng T, Yang H-Q. Three-year follow-up of Coats disease treated with conbercept and 532-nm laser photocoagulation. World J Clin Cases. 2020;8(24):6243–51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8668170","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":596930719,"identity":"4055d71a-8934-4dd1-8ee8-1cecbf1ba3ca","order_by":0,"name":"Ribo Peng","email":"","orcid":"","institution":"Chongqing Three Gorges Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ribo","middleName":"","lastName":"Peng","suffix":""},{"id":596930720,"identity":"26278893-37e7-4723-8785-6964ecabb818","order_by":1,"name":"Yi Zhu","email":"","orcid":"","institution":"Chongqing Three Gorges Central 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1","display":"","copyAsset":false,"role":"figure","size":627546,"visible":true,"origin":"","legend":"\u003cp\u003eFundus photograph of the right eye showing yellowish-white exudation and shallow retinal detachment in the temporal periphery.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/9aa1a6036db8886e85fabe84.png"},{"id":103732087,"identity":"b6471470-060e-45ed-91f6-bb663f888ece","added_by":"auto","created_at":"2026-03-02 09:19:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":658707,"visible":true,"origin":"","legend":"\u003cp\u003eFundus fluorescein angiography of the right eye demonstrating abnormal vessel dilatation and fluorescein leakage.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/ea58d0e47edd409289bf89d1.png"},{"id":103732089,"identity":"a32d7227-ab26-4daa-9dc6-78466da148ba","added_by":"auto","created_at":"2026-03-02 09:19:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":710978,"visible":true,"origin":"","legend":"\u003cp\u003eOptical coherence tomography of the right eye showing temporal neuroepithelial and pigment epithelial detachment.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/97bc752acfaff976c4e9312b.png"},{"id":103732091,"identity":"b1f57c69-bed1-45c2-9cc7-4207a7d8bcdb","added_by":"auto","created_at":"2026-03-02 09:19:56","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":440224,"visible":true,"origin":"","legend":"\u003cp\u003eOcular ultrasound of the right eye revealing a hyperechoic band-like lesion and retinal detachment.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/6998b3b1aa1407fcb9d5bb35.png"},{"id":104399770,"identity":"fa49b505-3934-43e7-a83d-dd38295f6a16","added_by":"auto","created_at":"2026-03-11 12:07:33","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":222349,"visible":true,"origin":"","legend":"\u003cp\u003eOrbital-enhanced MRI of the right eye showing temporal retinal thickening with hyperintensity on T1- and T2-weighted imaging.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/e3ce91cddb7302884357b8ef.png"},{"id":103732092,"identity":"4e41f917-d77e-44ea-a5e6-45e9f51fd2b9","added_by":"auto","created_at":"2026-03-02 09:19:56","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":983274,"visible":true,"origin":"","legend":"\u003cp\u003ePost-treatment fundus photograph showing reduced exudation, visible laser spots, and partial retinal reattachment.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/97396de64815d400a401c003.png"},{"id":107994026,"identity":"b7003aff-4ded-4063-a7d9-fe1eb10be0bf","added_by":"auto","created_at":"2026-04-28 10:41:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5076672,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8668170/v1/b1587d88-e297-4739-b37b-7ec8749c8aba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adult-Onset Coats Disease in a 61-Year-Old Woman: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eCoats disease, first described in 1908, is a congenital retinopathy characterized by retinal telangiectasia, lipid exudation, and progression to exudative retinal detachment[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although its etiology remains unclear, it may involve inflammation, metabolic disorders, or genetic mutations[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Pathologically, retinal vessel abnormalities, including arteriolar and capillary dilatation and vessel wall thickening, lead to blood-retinal barrier breakdown, causing retinal swelling and detachment[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While typically affecting young boys, adult-onset Coats disease is rare, often presenting with limited retinal involvement, less hemorrhage, and better visual prognosis[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This report describes the clinical features, diagnosis, and management of stage 3A Coats disease in a 61-year-old woman, highlighting the role of combined laser and anti-VEGF therapy.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 61-year-old woman presented to the Ophthalmology Department of Chongqing University Three Gorges Hospital on October 14, 2020, with a 3-month history of vision loss in her right eye, worsening over 6 days. She denied systemic conditions (e.g., diabetes, hypertension, hypercholesterolemia), infectious diseases, trauma, or surgery. Her personal, marital, obstetric, and family histories were unremarkable.\u003c/p\u003e \u003cp\u003eOn examination, her best-corrected visual acuity was 20/400 OD and 20/25. Pupils were reactive with no relative afferent pupillary defect, and intraocular pressure measurements were unremarkable, as were the results of the external examinations. Both eyes showed mild lens opacities, with normal anterior segments. Dilated fundus examination of the right fundus exhibited clear optic disc borders (cup-to-disc ratio: 0.3), retinal vessel dilatation, mild bluish-gray elevation, and massive yellowish-white exudation in the temporal periphery and shallow retinal detachment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Results of a dilated fundus examination of the left eye were unremarkable. Fundus fluorescein angiography (FFA) demonstrated abnormal vessel dilatation and terminal fluorescein leakage (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Optical coherence tomography (OCT) of the right eye (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed temporal neuroepithelial and pigment epithelial detachment (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Ocular ultrasound detected a hyperechoic band-like lesion and retinal detachment (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Magnetic resonance imaging of the orbit revealed right temporal retinal thickening with protrusion into the vitreous cavity, hyperintense on T1- and T2-weighted imaging (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Results were unremarkable in the left eye.\u003c/p\u003e \u003cp\u003eThe diagnosis was stage 3A Coats disease in the right eye and bilateral age-related cataracts. Informed consent was obtained for treatment and publication.\u003c/p\u003e \u003cp\u003eArgon laser photocoagulation was performed on the temporal superior exudative lesion and peripheral detachment area (spot size: 200\u0026ndash;300 \u0026micro;m, energy: 150\u0026ndash;170 J, exposure: 0.2 s). However, laser treatment was less effective in the detachment area. A periocular injection of triamcinolone acetonide (20 mg) was administered. At follow-up on April 6, 2021, Visual acuity was improved to 20/60 OD, with reduced exudation and detachment; laser spots were visible. However, OCT showed worsened macular cystoid edema (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The patient declined intravitreal triamcinolone due to concerns about steroid-induced glaucoma and opted for intravitreal conbercept (0.05 mL, 0.5 mg) injected 4 mm posterior to the limbus.\u003c/p\u003e"},{"header":"Discussion and conclusions","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003eCoats disease, characterized by retinal telangiectasia and exudation, results from vascular abnormalities resembling diabetic retinopathy, including pericyte loss and microaneurysm formation[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The breakdown of the blood-retinal barrier allows lipid-rich exudation into the retina and subretinal space, causing swelling and detachment[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Adult-onset Coats disease, as seen in this case, is rare, with reported onset ages ranging from 22 to 62 years. Unlike pediatric cases, adult-onset disease typically involves smaller lesions, less macular damage, and slower progression, often yielding better visual outcomes[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDiagnostic imaging is critical. Fundus photography and FFA confirm exudation and vascular abnormalities, while OCT and ultrasound assess macular edema and detachment severity[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. MRI in this case showed hyperintense signals, consistent with high-protein exudation[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Shields et al. classify Coats disease into five stages, with stage 3A indicating exudation and partial detachment, as observed here[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTreatment aims to eliminate abnormal vessels and exudation. Laser photocoagulation, used in this case, is effective for mild cases, closing abnormal vessels and reducing exudation[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Periocular triamcinolone promotes fluid absorption but carries risks of glaucoma[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Anti-VEGF agents, such as conbercept, reduce retinal edema and exudation by targeting elevated intraocular VEGF levels[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this case, combined laser and conbercept therapy improved visual acuity and reduced detachment, avoiding invasive procedures like vitrectomy. However, persistent macular edema suggests the need for ongoing monitoring. Systemic conditions like hypertension or diabetes, reported in some adult cases, were absent here.\u003c/p\u003e \u003cp\u003eAdult-onset Coats disease is a rare but important differential diagnosis for adults presenting with unilateral vision loss and exudative retinopathy. This case demonstrates that a multi-modal approach combining laser photocoagulation with periocular steroids and intravitreal anti-VEGF therapy can lead to favorable anatomical and functional outcomes, effectively managing the disease and avoiding the need for more invasive surgery. Further research is warranted to better understand the pathogenesis and optimize treatment strategies for both adult and juvenile forms of Coats disease.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eoptical coherence tomography\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOCT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eultrasound, and magnetic resonance imaging\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMRI\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eanti-vascular endothelial growth factor\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVEGF\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFundus fluorescein angiography\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFFA\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research has been approved by the ethics committee of Chongqing University Three Gorges Hospital .The patients informed consent to participate was obtained in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient provided written informed consent for the publication of the clinical data and images contained in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm their contribution to the paper as follows: \u003cstrong\u003eYi Zhu:\u0026nbsp;\u003c/strong\u003eanalyzed and interpreted the patient data.\u003cstrong\u003e\u0026nbsp;Xiaochun Yang:\u0026nbsp;\u003c/strong\u003etook and edited the images.\u003cstrong\u003e\u0026nbsp;Xiaoshuang Tang:\u0026nbsp;\u003c/strong\u003epatient treatment. \u003cstrong\u003eRibo Peng\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003ewriting-original draft.\u003cstrong\u003e\u0026nbsp;Na Li:\u003c/strong\u003e Writing-review \u0026amp; editing. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to all the peer reviewers and editors for their opinions and suggestions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorales AG. Coats' Disease*. Am J Ophthalmol. 1965;60(5):855\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSigler EJ, Randolph JC, Calzada JI, Wilson MW, Haik BG. Current management of Coats disease. Surv Ophthalmol. 2014;59(1):30\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhorbanian S, Jaulim A, Chatziralli IP. Diagnosis and Treatment of Coats\u0026rsquo; Disease: A Review of the Literature. Ophthalmologica. 2012;227(4):175\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUcgul AY, \u0026Ouml;zdek Ş. Coats\u0026rsquo; Disease: A Comprehensive Review of Its Pathophysiology, Diagnosis, and Advances in Treatment. Semin Ophthalmol. 2024;40(6):458\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanerjee M, Nayak S, Kumar S, Bhayana AA, Kumar V. Adult-onset Coats disease. Surv Ophthalmol. 2023;68(4):591\u0026ndash;600.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMary Stephen ST, Jayasri, Periyandavan. Kalyan Basa: A Brief Review on Adult-Onset Coats\u0026rsquo; Disease. Romanian J Ophthalmol 2024, 68(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJERRY A. SHIELDS M, SHIELDS CAROLL, MD SONTASHG, HONAVAR, MD, AND, HAKAN DEMIRCI M. Clinical variations and complications of Coats disease in 150cases: the 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001;131(5):561\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRishi P, Rishi E, Appukuttan B, Uparkar M, Sharma T, Gopal L. Coats\u0026prime; disease of adult-onset in 48 eyes. Indian J Ophthalmol 2016, 64(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou W, Liu Y-Y, Li M-X, Wu X-H, Liang J, Hao J, Liu S-N, Jin C-J. Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease. Int J Ophthalmol. 2024;17(8):1469\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuarnera A, Valente P, Pasquini L, Moltoni G, Randisi F, Carducci C, Carboni A, Lucignani G, Napolitano A, Romanzo A, et al. Congenital Malformations of the Eye: A Pictorial Review and Clinico-Radiological Correlations. J Ophthalmol. 2024;2024:1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShanmugam MP, Shah PN, Sagar P, Ramanjulu R, Mishra DK. Coats\u0026rsquo; disease \u0026ndash; Prognostic factors for globe and vision salvage in children, a long-term experience. Indian J Ophthalmol. 2022;70(2):483\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOli A, Balakrishnan D, Jalali S. Coats\u0026rsquo; disease: trends and long-term treatment outcomes in a tertiary referral centre. Therapeutic Adv Ophthalmol 2021, 13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerco E, Elsliger S, Weinberg T, Ghannam W, Shoham-Hazon N. Triple Trouble with Triple Solutions: A Unique Case Report of a Severe Exudative Retinal Detachment Accompanied by Retinal Traction and Two Retinal Holes in Coats Disease. Case Rep Ophthalmol. 2024;15(1):84\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang L, Qin B, Luo X-L, Cao H, Deng T-M, Yang M-M, Meng T, Yang H-Q. Three-year follow-up of Coats disease treated with conbercept and 532-nm laser photocoagulation. World J Clin Cases. 2020;8(24):6243\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adult Coats, conbercept, retinal photocoagulation, triamcinolone acetonide","lastPublishedDoi":"10.21203/rs.3.rs-8668170/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8668170/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCoats disease is a rare congenital retinopathy characterized by retinal telangiectasia and exudation, typically affecting young males. Adult-onset cases are uncommon and often present with milder manifestations.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003eA 61-year-old woman presented with a 3-month history of vision loss in her right eye, worsening over 6 days. Examination revealed right-eye visual acuity of 20/40, retinal vessel dilatation, yellowish-white exudation, and shallow retinal detachment in the temporal periphery. Fundus photography, fluorescein angiography, optical coherence tomography (OCT), ultrasound, and magnetic resonance imaging (MRI) confirmed stage 3A Coats disease and bilateral age-related cataracts. Treatment included argon laser photocoagulation and periocular triamcinolone acetonide, followed by intravitreal conbercept injection. Follow-up at 6 months showed reduced exudation, partial retinal reattachment, and improved visual acuity to 20/60, though macular edema persisted.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAdult-onset Coats disease can present with significant retinal exudation but a favorable prognosis with early intervention. Combined laser and anti-vascular endothelial growth factor (VEGF) therapy may improve outcomes.\u003c/p\u003e","manuscriptTitle":"Adult-Onset Coats Disease in a 61-Year-Old Woman: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-02 09:19:51","doi":"10.21203/rs.3.rs-8668170/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ac48786-f767-4a50-8eb6-cd2924cf3fc7","owner":[],"postedDate":"March 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T10:40:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-02 09:19:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8668170","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8668170","identity":"rs-8668170","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}