This 14YO boy received thermal laser photocoagulation for an exudative retinal detachment in his right eye from Coats disease about 10 years earlier. There were no new complaints, and vision was stable at 20/400. His normal left eye was 20/20.
Optos color RG imaging shows peripheral superotemporal scarring and subretinal fibrosis. A venous retinal-choroidal anastomosis is noted. Some variably pigmented laser scars are seen, and there are no active Coats lesions. A nematode-like area of subfoveal scarring is seen more centrally with variable outer retinal thinning and edema.
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).
Under normal conditions, the retinal and choroidal circulations remain separate and distinct. Rarely, the two circulations connect directly through a chorioretinal anastomosis. These can occur in chorioretinal scars, typically from inactive toxoplasmosis lesions, macular telangiectasia, and disciform scars.
