Purpose <p>To determine the effectiveness of pars plana vitrectomy (PPV) in treating eyes with advanced Coats disease with an exudative retinal detachment.</p> Study design <p>Clinical investigation.</p> Methods <p>Retrospective and consecutive series of 7 patients with Coats disease. All patients underwent PPV for an exudative or tractional retinal detachment. External subretinal fluid (SRF) drainage was performed for the extensive exudative retinal detachment. The demographics of the patients, surgical procedures, postoperative anatomical outcomes, changes in visual acuity, and complications are presented.</p> Results <p>Seven eyes of 6 male patients (mean age, 13.9 years) underwent PPV between 2017 and 2024. The PPV was performed with membrane peeling in 7 eyes, and external SRF drainage in 4 eyes. Two eyes required multiple PPVs. The retina was reattached in all cases, including one eye in which the retina was reattached with silicone oil tamponade and encircling buckling due to anterior proliferative vitreoretinopathy and hypotony. One eye developed neovascular glaucoma requiring a glaucoma tube-shunt implant, and cataracts developed in three eyes. The mean visual acuity at the baseline of 1.51 logMAR units was significantly improved to 0.88 logMAR units at postoperative 6 months (<i>P =</i> 0.028).</p> Conclusion <p>PPV with dissection of the tractional membrane is a good option for treating exudative retinal detachment in eyes with advanced Coats disease; the treatment results in reattachment and improvement in the visual acuity.</p>