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47 year old man with a peripheral retinal lesion found on routine exam
Digital Journal of Ophthalmology 1997
Volume 3, Number 23
July 30, 1997
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Michael A. Kapusta, M.D., FRCS(C) | Doheny Eye Institute, University of Southern California, Los Angeles, California
Michael B. Yang, M.D. | Doheny Eye Institute, University of Southern California, Los Angeles, California
Talia Kolin, M.D. | Doheny Eye Institute, University of Southern California, Los Angeles, California
Lawrence P. Chong, M.D. | Doheny Eye Institute, University of Southern California, Los Angeles, California
Diagnosis and Discussion
Coat's Disease

Coats' disease is characterized by massive hard exudates associated with congenital retinal telangiectasias. Vascular anomalies including fusiform venous dilatation, microaneurysms, perivasculitis, collateral vessels, and nonperfusion of the retina, may be present in variable degrees. Hemorrhage may occur, as well. Abnormal vessels leak INTO and under the retina. Exudation tracking under the retina is termed as a Wise response. When such exudation is accompanied by a sensory retinal detachment, it is termed as a Coats' response. This may appear, clinically, as leukocoria. While initially painless, Coats' disease may progress to glaucoma, retinal detachment, cataract, and phthisis.

Coats' disease occurs in males three to eight times more frequently than females. There is no inheritance pattern or racial predilection. It is unilateral in 80% of cases. The common adolescent form occurs before the age of sixteen. It tends to progress faster in children under the age of four. Less frequently, patients present at a later age with the adult form.

Our patient presented at age 27 with a vascular anomaly that was diagnosed as Coats' disease. There was no family history. The previous lesion was unilateral and treated extensively with laser photocoagulation. The new lesion was found adjacent to the area of photocoagulation and was characterized by exudates and retinal thickening surrounding an area of capillary nonperfusion with vessel dilatation. The aneurysm in the center of this area did not have a feeding or draining vessel, which would be characteristic of a retinal angioma. Therefore, further investigations of the brain and kidneys for the presence of aneurysms was deemed unnecessary. Ultrasonography and fine-needle aspiration biopsy may be helpful in differentiating advanced Coats' disease FROM other causes of leukocoria, especially in cases where it is necessary to rule out malignancy. Our patient presented at an early stage, with a benign process. Echography and biopsy were not indicated.

The patient was treated with photocoagulation to the aneurysmal lesion to stimulate its closure. Grid photocoagulation to the surrounding retina was also performed to promote resolution of retinal edema.
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