Adult-Onset Coats Disease With Rapid Progression to Full-Thickness Macular Hole: A Case Report

We present an atypical case of adult-onset Coats disease in a 39-year-old woman with rapid progression and the development of a full-thickness macular hole despite multimodal non-surgical treatment. The patient presented to the emergency department with sudden deterioration of vision in the left eye lasting three days. Fundus examination revealed peripapillary hemorrhages, vitreous condensations, and focal exudation in the inferotemporal quadrant. Optical coherence tomography showed retinal thickening, intraretinal and subretinal fluid, and an epiretinal membrane. Fluorescein angiography demonstrated abnormal peripheral vessels with surrounding non-perfusion. The patient was treated with laser photocoagulation, intravitreal bevacizumab injections, and cryotherapy. Despite temporary stabilization, follow-up examinations showed progression of exudative and hemorrhagic changes, with subsequent formation of a full-thickness macular hole. Pars plana vitrectomy was performed. Postoperative optical coherence tomography confirmed closure of the macular hole. This case highlights that adult-onset Coats disease may present with an atypically aggressive course and that conservative treatment may be insufficient in selected adult patients.