This video describes different surgical approaches for the treatment of advanced Coats disease. In eyes with bullous retinal detachment, the addition of external drainage of subretinal fluid to ablative procedures like laser photocoagulation and cryotherapy results in preservation of the lens and vitreous ends up with good anatomical results. Vitrectomy is usually reserved for cases with epiretinal or vitreous membranes and vitreous opacities or hemorrhages. Internal drainage should be avoided in these cases. A combined approach with external drainage and vitrectomy in addition to ablative procedures usually gives the best results, with long-lasting effects. A representative case for each will be presented in this video.