A 9-year-old boy presented with an exudative retinal detachment, vascular telangiectasias, subretinal lipid, and retinal macrocyst formation. He underwent three sessions of large-spot diode laser for the treatment of Coats' disease. Serial examinations and fundus photography documented an excellent involutional response with an improvement in visual acuity. J Pediatr Ophthalmol Strabismus 2005;42:367–368.
A 9-year-old boy was referred to the Vitreoretinal Surgical Service of the Bascom Palmer Eye Institute, Miami, Florida, because of an exudative retinal detachment. He had no significant medical or surgical history, and his family history was unremarkable. On evaluation, the visual acuity was 20/20 in the right eye and 5/200 in the left eye. The results of a dilated retinal examination of the right eye were normal. Evaluation of the left eye showed peripapillary lipid deposition with macular extension. Peripherally, there were vascular telangiectasias with an associated exudative retinal detachment, subretinal lipid, and retinal macrocyst formation (Fig. 1). Fluorescein and echography studies together with a clinical examination yielded results consistent with Coats' disease.
Initial presentation with (A) an extensive exudative retinal detachment and (B) early macrocyst formation.
Ablation with a large-spot diode laser was performed on the left eye in the area of the vascular telangiectasias. This was performed three times during 6 months. Visual acuity improved to 20/200 after laser treatment. There was complete resolution of the exudative retinal detachment, and the retinal macrocyst had a significant involutional response (Fig. 2).
Six months after initial laser treatment, (A) the subretinal exudate is resolving and (B) the retinal macrocyst is consolidated.
Coats' disease is a retinal vascular abnormality resulting in formation of telangiectasias and microaneurysms that lead to massive intraretinal and subretinal exudation, retinal detachment, and neovascular glaucoma often necessitating enucleation. Studies have shown that the prognosis for advanced Coats' disease after appropriate laser treatment is best when less than 180° of the retina is affected without retinal detachment.1–3 Although laser photocoagulation is the preferred treatment modality for this condition, retinal cryopexy also is effective in cases with extensive retinal detachment or in cases in which media impairs the application of laser treatment.
This case of Coats' disease had a complex retinal detachment, large subretinal lipid exudates involving nearly 360° of the retina, and retinal macrocyst formation. Macrocysts are an uncommon but recognized finding in severe Coats' disease. Our patient was treated with a large-spot laser delivered by indirect ophthalmoscopy three times at an interval of 3 to 4 months apart. The eye responded remarkably well, with resolution of the exudative retinal detachment within 2 months, reduction in the dimensions of the telangiectasias, and involution of the retinal macrocyst. We suggest that severe Coats' disease with a near total exudative retinal detachment should be treated aggressively with a laser to maximize visual outcome and preserve the globe.
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