Purpose: To evaluate the efficacy and safety of adjunctive intravitreal anti-vascular endothelial growth factor (VEGF) therapy combined with standard ablative treatment in Coats disease. Methods: A search of PubMed, Embase, and SCOPUS was conducted to identify studies comparing ablative therapy alone versus ablative therapy with anti-VEGF for Coats disease. Five studies (136 eyes treated with ablation alone and 82 with combination therapy) were included. Data on treatment sessions, quiescence, visual acuity (VA) and tractional retinal detachment (TRD) were extracted. Results: Adjunctive anti-VEGF significantly reduced the treatment sessions required to achieve quiescence (Mean difference [MD] 0.47 sessions, 95% confidence interval [CI] 0.10-0.85, p = 0.01). No significant difference was found in anatomic outcomes with both groups having a similar number of eyes which resulted in phthisis. No significant difference was found in the BCVA at final follow up (MD = 0.20, 95% CI -0.20 to 0.59, p = 0.33) without significant heterogeneity (I ² =23%, p = 0.28). Eyes with adjunctive anti-VEGF were not found to be associated with a significantly higher risk of TRD (RR 2.64, 95% CI 0.34-20.30, p = 0.35). Due to the retrospective design of the included studies, the overall grade of evidence was deemed low. Conclusions: Adjunctive anti-VEGF therapy may reduce the total treatment burden while achieving similar anatomical and functional outcomes. In addition, there appears to be no significant increase in the risk of TRD. Judicious use of anti-VEGF may be a useful therapy to consider in patients with Coats disease requiring ablative therapy.