Journal of Pediatric Ophthalmology and Strabismus

Images in Pediatric Ophthalmology 

Clinical and Magnetic Resonance Imaging in Unilateral Coats' Disease

Rishabh Verma, MBBS (Hons); Ario Wilson-Pogmore, MD; Heather Russell, FRANZCO; Sandeep Bhuta, FRANZCR

Abstract

Coats' disease is a rare ophthalmologic disorder characterized by subretinal or intraretinal exudates and retinal telangiectasias.1 A 3-year-old boy suspected of having right-sided Coats' disease and a complete retinal detachment underwent treatment with laser, cryotherapy, and intravitreal bevacizumab. An Optos California Ultra Widefield (Nikon Healthcare Japan, Tokyo, Japan) image of the right eye 2 months after drainage of subretinal fluid, repeat cryotherapy, and repeat laser panretinal photocoagulation revealed a partial resolution of stage 4 total exudative retinal detachment (lacking the folds characteristic of rhegmatogenous retinal detachment), supratemporal telangiectatic vessels, extensive peripheral vascular dilatation, and extensive hard exudates (Figure 1A). A composite RetCam (Clarity Medical Systems, Pleasanton, CA) fundus fluorescein angiography image of the right eye revealed the classic “light bulb” aneurysmal dilatation inferotemporally, which is pathognomonic for Coats' disease (Figure 1B). Because the patient did not respond to treatment, magnetic resonance imaging of the orbits was performed to exclude a diagnosis of retinoblastoma. Subretinal collection was seen on T1 and T2 fat-saturated images, and a high T1 signal (not shown) implied the lipid content of the effusion (Figure 1C). The exudative subretinal effusion was visible on magnetic resonance imaging, typical of Coats' disease.2 A subtotal retinal detachment was also observed on the right temporal aspect with preserved attachment to the optic nerve head, which correlates with Coats' disease (stage 3a/3b). High-resolution T2 SPACE Axial (0.9 mm) images have high spatial resolution, illustrate retinal detachment well, and are an imaging sequence of choice for patients with this clinical condition.3

Coats' disease is a rare ophthalmologic disorder characterized by subretinal or intraretinal exudates and retinal telangiectasias.1 A 3-year-old boy suspected of having right-sided Coats' disease and a complete retinal detachment underwent treatment with laser, cryotherapy, and intravitreal bevacizumab. An Optos California Ultra Widefield (Nikon Healthcare Japan, Tokyo, Japan) image of the right eye 2 months after drainage of subretinal fluid, repeat cryotherapy, and repeat laser panretinal photocoagulation revealed a partial resolution of stage 4 total exudative retinal detachment (lacking the folds characteristic of rhegmatogenous retinal detachment), supratemporal telangiectatic vessels, extensive peripheral vascular dilatation, and extensive hard exudates (Figure 1A). A composite RetCam (Clarity Medical Systems, Pleasanton, CA) fundus fluorescein angiography image of the right eye revealed the classic “light bulb” aneurysmal dilatation inferotemporally, which is pathognomonic for Coats' disease (Figure 1B). Because the patient did not respond to treatment, magnetic resonance imaging of the orbits was performed to exclude a diagnosis of retinoblastoma. Subretinal collection was seen on T1 and T2 fat-saturated images, and a high T1 signal (not shown) implied the lipid content of the effusion (Figure 1C). The exudative subretinal effusion was visible on magnetic resonance imaging, typical of Coats' disease.2 A subtotal retinal detachment was also observed on the right temporal aspect with preserved attachment to the optic nerve head, which correlates with Coats' disease (stage 3a/3b). High-resolution T2 SPACE Axial (0.9 mm) images have high spatial resolution, illustrate retinal detachment well, and are an imaging sequence of choice for patients with this clinical condition.3

References

  1. Tarkkanen AH, Laatikainen LE. Coat's disease: clinical, angiographic, histopathological findings and clinical management. Br J Ophthalmol. 1983;67(11):766–776. doi:10.1136/bjo.67.11.766 [CrossRef]6685529
  2. Razek AA, Elkhamary S. MRI of retinoblastoma. Br J Radiol. 2011;84(1005):775–784. doi:10.1259/bjr/32022497 [CrossRef]21849363
  3. Rauschecker AM, Patel CV, Yeom KW, et al. High-resolution MR imaging of the orbit in patients with retinoblastoma. Radiographics. 2012;32(5):1307–1326. doi:10.1148/rg.325115176 [CrossRef]22977020
Authors

From the Departments of Medical Imaging (RV, SB) and Ophthalmology (AW-P, HR), Gold Coast University Hospital, Southport, Queensland, Australia, and Griffith University School of Medicine, Southport, Queensland, Australia (SB).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Rishabh Verma, MBBS (Hons), Gold Coast University Hospital, 1 Hospital Blvd., Southport, Queensland 4215, Australia. E-mail: rishabhs.verma@gmail.com

10.3928/01913913-20190613-03

Sign up to receive

Journal E-contents