This 53YO has classic findings of Coats disease. A leaking macroaneurysm in the distal inferotemporal macula is causing exudation with lipid threatening the macular center. Prior macular laser scars are noted in the superior macula.
There is a fibrosed macroaneurysm in the temporal midperiphery, and some fibrosed telangiectatic lesions are visible in the superonasal periphery. Scattered peripheral hyperpigmented laser scars are also seen.
Fluorescein angiography nicely shows these findings and more, including macular telangiectasia with staining laser scars, some patches of mid-peripheral telangiectasia and capillary loss, and a large region of temporal capillary loss.
Learning Points:
Laser photocoagulation can be used to treat leaking macroaneurysms and telangiectatic vessels in Coats disease. Anti-VEGF injections can also be used to stabilize vascular leakage.
