History/Chief Complaint

  • A 39 year old black female presented for a second opinion for a lesion previously diagnosed as an isolated hemangioma in the temporal retina OS. She had no visual symptoms, no relevant family or health history. She was not premature, had no skin lesions, had a normal hemoglobin electrophoresis and no evidence of auto-immune disease.

Clinical Findings

  • BCVA: 20/20 OD and 20/20 OS
  • Fundus exam: An unremarkable posterior pole OU but a large mass surrounded by exudates in the far temporal retina OS and a large area of white without pressure in the far temporal retina OD.
  • Matrix threshold visual field: very subtle reduction in sensitivity with no diagnostic pattern OU.

optomap® Fluorescein Angiogram

  • Leakage around a large, somewhat elevated lesion in the temporal retina OS.
  • A large area of ischemia in the far temporal retina with multiple areas of capillary non-perfusion OS.
  • A similar zone of capillary non-perfusion in the far temporal retina OD.
  • Small sacular aneurysms adjacent to zones of ischemia OU.

Diagnosis

  • Probable Coats Disease or Coats like peripheral exudation and ischemia OS.
  • Retinal telanglectasia (or pre Coats) OD.
  • Other etiologies were also considered (see page 18).

Treatment

  • Two retinologists recommended laser to the large temporal lesion OS but others opined that only careful follow-up for any progression is warranted at present. The patient has opted for careful follow-up without treatment. There has been no progression over an 8 month period.