This 28YO healthy male was referred for asymptomatic findings on retinal examination in his left eye. Vision was 20/20 in his normal OD and 20/20 OS.
Optos color RGB imaging shows scattered temporal lipid and telangiectatic vessels. A large macroaneurysm is noted. The retina distal to the lipid is featureless and clinically ischemic.
Fluorescein angiography shows the telangiectasia becoming more prominent and ischemic as it extends from the distal temporal macula into the periphery. There is marked leakage at the junction of the perfused and ischemic retina. Scatter laser to the ischemic retina, along with a focal laser to the macroaneurysm, was scheduled.
Learning Points:
Described by George Coats in 1908, Coats disease is an idiopathic disorder that is usually unilateral in males. It is characterized by retinal vascular telangiectasia involving capillaries, arterioles, and venules. Patients can present with a wide variety of findings ranging from minimal exudation to total exudative retinal detachment.
The leaking vessels are usually treated to prevent exudative complications. Thermal laser photocoagulation is usually the initial modality, but anti-VEGF injections can also be used to stabilize the vascular leakage. Patients will often require multiple rounds of treatment.
See Sigler et al for a review of the current management (Survey Ophthalmology 2014;59:30-46).
