Coats disease: A narrative review of clinical spectrum, imaging features, and contemporary management.

Coats disease is a rare idiopathic retinal vascular disorder characterized by telangiectatic and aneurysmal retinal vessels, intraretinal and subretinal lipid exudation, and variable progression to exudative retinal detachment, secondary glaucoma, and severe visual loss. This narrative review summarizes the clinical spectrum, diagnostic evaluation, imaging features, and contemporary management of Coats disease, with emphasis on areas of diagnostic uncertainty and treatment controversy. The disease most commonly affects young males and is classically unilateral; however, rare bilateral presentations and Leber miliary aneurysms should be recognized within the broader spectrum of idiopathic retinal telangiectatic disease. Modern multimodal imaging, including wide-field photography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography, has improved detection of peripheral nonperfusion, macular edema, subfoveal lipid, photoreceptor damage, and vascular abnormalities with prognostic implications. Management remains stage-dependent. Laser photocoagulation and cryotherapy remain the foundation of treatment, while anti-vascular endothelial growth factor therapy, corticosteroids, photodynamic therapy, and surgery have selective roles as adjunctive or advanced-stage interventions. The evidence base is limited by heterogeneous retrospective series, small case reports, and scarce comparative prospective data. Further multicenter studies are needed to define treatment algorithms, imaging biomarkers, long-term safety, and functional outcomes.