Supplementary Material for: 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

<b><i>Introduction:</i></b> Coats disease is a rare vasculature pathology that usually presents as retinal telangiectasia with possible progression to exudative retinal detachment (RD). Intravitreal anti-VEGF injections, cryotherapy, laser photocoagulation, and surgery are commonly used to control the disease and prevent its progression. Although iatrogenic tractional RDs secondary to anti-VEGF injections have been reported in patients with Coats disease, RDs in Coats disease are exudative, secondary to retinal exudation and vascular abnormalities. In this article, we present the first reported case of a severe exudative RD accompanied by retinal traction and two retinal holes in a patient with Coats disease. <b><i>Case Presentation:</i></b> A 32-year-old male initially presented with Coats disease stage 2A, which then progressed to 3A1 within a month of close follow-ups, finally leading to exudative RD. Following cryotherapy and bevacizumab injections, the exudative RD progressed, with the emergence of retinal traction and two retinal holes. This complex case was successfully treated with a scleral buckle vitrectomy accompanied by radial elements to support the RD, pars plana vitrectomy, silicon oil tamponade, and post-surgical bevacizumab injections. Six months following the surgical intervention, the patient’s vision is restored at 20/30, and retinal imaging shows a totally flattened retina. <b><i>Conclusion:</i></b> We present the first reported case of a severe exudative RD accompanied by retinal traction and two retinal holes in a patient with Coats disease. The combination of surgical treatment and bevacizumab injections is thought to have collectively contributed to our patient’s favorable outcome.

**引言：** 科茨病（Coats disease）是一种罕见的血管性病变，常表现为视网膜毛细血管扩张症，可进展为渗出性视网膜脱离（retinal detachment, RD）。临床常用玻璃体内抗血管内皮生长因子（anti-VEGF）注射、冷凝治疗、激光光凝术及手术手段控制病情、阻止进展。尽管已有科茨病患者接受抗VEGF注射后继发医源性牵拉性视网膜脱离的报道，但科茨病相关视网膜脱离多为渗出性，继发于视网膜渗出及血管异常。本文报告首例科茨病患者合并严重渗出性视网膜脱离伴视网膜牵拉及两个视网膜裂孔的病例。

**病例介绍：** 一名32岁男性患者初始诊断为2A期科茨病，在1个月的密切随访期间进展至3A1期，最终进展为渗出性视网膜脱离。予冷凝治疗及贝伐珠单抗（bevacizumab）注射后，渗出性视网膜脱离进一步进展，出现视网膜牵拉及两个视网膜裂孔。该复杂病例通过巩膜扣带术（scleral buckle）联合放射状支撑物以复位视网膜脱离、经睫状体平坦部玻璃体切割术（pars plana vitrectomy）、硅油填充术（silicon oil tamponade）联合术后贝伐珠单抗注射成功治疗。术后6个月，患者视力恢复至20/30，视网膜影像学检查显示视网膜完全复位。

**结论：** 我们报告首例科茨病患者合并严重渗出性视网膜脱离伴视网膜牵拉及两个视网膜裂孔的病例。手术治疗联合贝伐珠单抗注射被认为共同促成了患者的良好预后。