Shunji Kusaka discusses treatment of severe Coats disease using vitrectomy, perfluorocarbon, and external subretinal drainage. The medical records of 10 eyes of 10 patients with Coats disease that had undergone surgery for total RD were reviewed. Vitrectomy and injection of perfluorocarbon liquid (PFCL), followed by external drainage of subretinal fluid (SRF), were performed on all eyes. The retinas were successfully reattached in 8 eyes, with a mean follow-up of 18.9 months. In the other 2 eyes, the retinas remained detached due to reproliferations. These results indicate that vitrectomy, use of PFC, and external SRF drainage are effective in reattaching the retina in eyes with advanced Coats disease.