Fluorescein Angiographic Abnormalities in the Contralateral Eye with Normal Fundus in Children with Unilateral Coats' Disease

Abstract

Purpose: We report the detection of peripheral retinal vascular abnormalities in the fellow eye with normal fundus in children with unilateral Coats' disease.

Methods: The clinical records of patients diagnosed with Coats' disease were retrospectively reviewed. We recorded the subjects' characteristics and obtained fundus photography and fluorescein angiography (FA) images. The main outcome measure was peripheral vascular abnormalities in the contralateral eye with normal fundus in children with unilateral Coats' disease, observed with FA.

Results: Out of 47 patients with Coats' disease, two (4.3%) were diagnosed with clinically bilateral Coats' disease. Of the 45 patients with presumed unilateral Coats' disease, four (8.9%) had bilateral abnormal peripheral vasculature in FA. The mean age of these four patients was 6.4 ± 5.4 years (range, 1 to 14 years), and three patients were male (75%). All four had peripheral retinal nonperfusion, and two (50%) received laser photocoagulation due to peripheral leakage with telangiectatic vessels.

Conclusions: Coats' disease may more often be a bilateral disease with asymmetry than previously thought. Patients with Coats' disease should undergo careful examination of the fellow eye with FA in order to detect and treat vascular abnormalities that are not visible clinically.

Keywords: Bilateral; Fluorescein angiography; Peripheral nonperfusion; Retinal telangiectasis.

Fig. 1. Color fundus photography and fluorescein angiography were performed using the RetCam during an examination under anesthesia (patient 1). Fundus photography showing (A) no definite abnormal vasculature in the right eye and (B) widespread yellowish exudates with partial cystic change and vascular telangiectasia in the left eye. (C) Fluorescein angiogram (1:58) demonstrating a peripheral avascular retina bordered posteriorly by leaking telangiectasias in the right eye. (D) Laser photocoagulation was applied to the peripheral avascular retina in the right eye.

Fig. 2. Color fundus photography and fluorescein angiography of patient 3. Fundus photography showing (A) yellowish exudates with vascular telangiectasia in the right eye and (B) no definite abnormal vasculature in the left eye. (C) Fluorescein angiogram (1:07) demonstrating peripheral avascular retina, shunt vessels, and leaking telangiectasias in the left eye. (D) Laser photocoagulation with a large spot diode laser was applied around the leaking telangiectasias in the left eye.

Fig. 3. Color fundus photography and fluorescein angiography of patients 2 (A–C) and 4 (D–F). (A,D) Fundus photography showing no definite abnormal vasculature in the contralateral eye of either patient. Early phase fluorescein angiogram of patients 2 (B, 1:19) and 4 (E, 0:52), demonstrating peripheral nonperfusion, capillary bed closure, and shunt formation (arrow). However, no leakage was confirmed in either patient. (C,F) Fundus photography showing yellowish exudates and vascular telangiectasia in the affected eyes of both patients. (C) Laser photocoagulation was applied in the left eye in patient 2.