to report a case of coats disease managed with the dexamethasone intravitreal implant ozurdex ( allergan , inc . a 46-year - old female with 20/200 visual acuity was diagnosed with coats disease with secondary retinal vasoproliferative tumor . an initial approach was performed with an intravitreal injection of the sustained - release dexamethasone implant ozurdex . ozurdex may be an effective initial therapeutic approach for coats disease with immediate anatomical response and visual improvement . coats disease is a unilateral , idiopathic retinal vascular abnormality characterized by telangiectatic retinal vessels in association with lipid exudation . although most cases are diagnosed before the age of 20 years , coats disease may also be diagnosed in adult patients . current therapeutic strategies include observation , ablation of abnormal retinal telangiectasis by photocoagulation  or cryotherapy  and surgery for retinal detachment . recent publications regarding the off - label use of triamcinolone [ 3 , 4 ] or vascular endothelial growth factor inhibitors [ 5 , 6 , 7 ] have been published with inconclusive outcomes , requiring several rounds of retreatment in most cases . the purpose of any treatment for coats disease is to establish a prompt and long - standing visual recovery , with the safest profile for patients . a 46-year - old female was referred to our department with a 3-week history of progressive vision loss in her left eye . the best corrected visual acuity ( bcva ) anterior segment examination was unremarkable . whereas the right eye fundus did not show any significant change , in the left eye massive exudation within the inferior - temporal quadrant of the retina was evident , with posterior pole involvement and intraretinal lipid accumulation . in addition , a grayish mass was observed in the inferior peripheral retina ( fig . 1 ) . spectral - domain optical coherence tomography ( sd - oct ) confirmed the presence of exudative retinal detachment with macular involvement ( fig . an echography showed an intraretinal mass ( 4.1  1.9 mm ) located in the inferior periphery , associated with the exudative retinal detachment ( fig . 1 ) revealed the presence of telangiectatic vessels scattered all over the inferior - temporal retinal quadrant ; the peripheral inferior mass was identified as a retinal vasoproliferative tumor ( rvt ) with clearly defined afferent and efferent vessels . with the presumptive diagnosis of coats disease with exudative inferior - temporal retinal detachment and secondary rvt , the patient was treated with an intravitreal injection of the sustained - release dexamethasone implant ozurdex ( allergan , inc . , one week later , her bcva improved to 20/40 and sd - oct revealed a complete resolution of the exudative retinal detachment ( fig . the telangiectatic vessels were treated with laser photocoagulation guided by fluorescein angiography in 3 consecutive sessions with 15-day intervals . the volume of the rvt decreased progressively until complete retinographic and echographic disappearance . through the follow - up , no further recurrences of the exudative retinal detachment were found , and the extensive lipid exudation progressively regressed . one year after initial treatment with intravitreal ozurdex , the patient 's bcva was 20/25 ( fig . the pathogenesis of coats disease includes impairment of the blood - retinal barrier resulting in both intraretinal and subretinal fluid , and blood and lipid accumulation . in addition , weakening of the retinal vessel walls leads to the formation of telangiectasis , aneurysms and progressive leakage , resulting in exudative retinal detachment . one of the possible complications of coats disease is the development of secondary rvt , as evidenced in our patient 's case . this fact may be of great help in the management of coats disease , given the underlying inflammatory component . ozurdex is a novel , biodegradable , sustained - release dexamethasone delivery system approved for the treatment of macular edema following retinal vein occlusion . recently published clinical trials expand the efficacy of ozurdex to the management of diabetic macular edema   and uveitic macular edema . in our patient 's case , a single injection of ozurdex was able to dramatically improve visual acuity and resolve the exudative retinal detachment . further photocoagulation may lead to closure of telangiectasis ; no further recurrence of exudation was seen through a 12-month follow - up . further studies are warranted in order to confirm the high efficacy of ozurdex in the initial management of coats disease .
purposeto report a case of coats disease managed with the dexamethasone intravitreal implant ozurdex ( allergan , inc . , irvine , calif . 
 , usa ) combined with retinal photocoagulation.methodsa 46-year - old female with 20/200 visual acuity was diagnosed with coats disease with secondary retinal vasoproliferative tumor . 
 an initial approach was performed with an intravitreal injection of the sustained - release dexamethasone implant ozurdex . 
 after reattachment of the retina , the telangiectatic vessels were treated with laser photocoagulation.resultsthe patient 's visual acuity improved to 20/25 after the intravitreal ozurdex . 
 no further recurrences of exudation were evident through the 12-month follow-up.conclusionsozurdex may be an effective initial therapeutic approach for coats disease with immediate anatomical response and visual improvement .