 Answers | |  |
Answer 1[Figure 1] - Fundus picture of the left eye showing the blurred disc margin, engorgement of retinal vessels and extensive yellowish subretinal exudates.
[Figure 2] - Fundus picture of midperipheral retina. (a)Retinal telengectasia and subretinal exudation.
(b ) Subretinal exudation associated with retinal macrocyst and shallow exudative retinal detachment.
[Figure 3] B-scan of the left eye showing shallow exudative retinal detachment. Vitreous is clear.
Answer 2Coats Disease.
Answer 3Retinoblastoma, persistant hyperplastic primary vitreous and toxocariasis.
Answer 4- Ultrasonography - can confirm the disease extent. The absence of calcification and choroidal mass lesion can exclude potential malignancy which can present with coats like retinopathy.
- CT scan and MRI - particularly useful in differentiating advanced cases of coats disease from retinoblastoma. It can demonstrate calcification which is seen in retinoblastoma. Also can exclude subretinal lesions, extraocular and intracranial lesions such as metastasis from underlying malignancy.
| Discussion | | |
Coats disease is an idiopathic retinal condition characterized by retinal telengectasis, intraretinal and subretinal exudates which can lead to retinal detachment. It is mostly unilateral and usually affects males during childhood. Most patients presents clinically with unilateral blurred vision, strabismus or leukocoria. The most important differential diagnosis is retinoblastoma which is seen in the same age group and has some overlapping clinical features. Investigations like ultrasonography, CT and MRI can confirm the diagnosis by excluding calcification and other subretinal and extraocular masses.
Fluorescein angiography can detect early cases of retinal telengectasis in the peripheral retina.
Current clinical management is based on the severity of disease based on the classification by Shields
et al. Early cases are managed by ablative therapy using laser or thermal photocoagulation. Advanced cases are managed by pars plana vitrectomy. Recently, anti-VEGF agents are being used as adjunct treatment in selected cases.
