A Case of Coats Disease and Concurrent Anisometropic Amblyopia

Abstract

Purpose: The aim of this report was to demonstrate a case of Coats disease in a patient with concurrent anisometropic amblyopia.

Observations: A 10-year-old boy was diagnosed with Coats disease during routine ophthalmic examination. Visual acuity was 20/20 OD and 20/50 OS with cycloplegic refraction of +1.25 (OD) and +3.25 (OS). Examination under anesthesia showed macular exudates in the left eye that encroached near the fovea superotemporally. Despite the poor visual acuity and macular exudates, the foveal architecture of both eyes appeared normal on spectral domain optical coherence tomography. Because of the differing refractive error between the two eyes in the presence of foveal-sparing exudates, anisometropic amblyopia was suspected. After initial laser therapy, the patient was started on a daily patching regimen of the right eye. The patient's vision steadily improved to 20/25 OS with a final cycloplegic refraction of +1.00 (OD), +3.00 (OS) at 2 years. This report demonstrates the importance of assessing for other common and treatable causes of vision loss in the setting of Coats disease.

Conclusions and importance: This case demonstrates the importance of detecting and correcting for concurrent amblyopia in pediatric retina conditions that may, on fundus examination alone, appear to have a retinal cause for reduced visual acuity.

Keywords: Coats disease; amblyopia; anisometropia; pediatrics; retina.

Fig. 1

Fundus photos of left eye showing superotemporal macular exudates at presentation (A), resolving exudates 6 months after initial presentation and treatment (B), and completely resolved exudates at 2 years (C).

Fig. 2

Montage of fundus photos of left eye at initial presentation showing exudates in the superotemporal macula and superior and nasal to optic nerve (A). Vascular abnormalities are present in the superotemporal peripheral retina (arrow). By 2 years, all exudates had resolved and the previously laser-treated retina is visualized in the superotemporal periphery (B).

Fig. 3

Optical Coherence Tomography image upon initial presentation demonstrated macular exudates encroaching superotemporally (A). However no foveal exudates or edema were visualized (B), suggesting the hyperopia was refractive in etiology.