Resolution of exudative retinal detachment and regression of retinal macrocyst post-laser in Coats disease
A 15-year-old boy presented with painless progressive blurring of vision in the right eye for one year in duration. It was not associated with floaters or fashes of light and there was no history of trauma. He was born full term via spontaneous vaginal delivery and had no past ocular history or medical illness.\nVisual acuity in his right eye was hand movement and his left visual acuity was 6/6. Anterior segment examination was normal with a normal pupillary reaction in both eyes. The right fundus showed the presence of extensive subretinal exudates at the posterior pole (macular area) extending to the superotemporal arcade (). There was also the presence of a retinal macrocyst at the temporal periphery of the retina (). This was associated with exudative retinal detachment at the inferior periphery of the retina with no foveal involvement. There was the presence of telangiectatic retinal vessels at the superotemporal retina. The left fundus was normal with an absence of subretinal exudates or any abnormal retinal vessels. B-scan ultrasound showed the presence of inferior retinal detachment with no mass lesion or calcification. Fundus angiography revealed telangiectatic retinal vessels at the superotemporal retina.\nBased on clinical and angiographic findings, a diagnosis of Coats disease in the right eye was made. The patient was classified as having Coats disease stage 3A based on the presence of exudative retinal detachment with no foveal involvement. He was treated with retinal laser photocoagulation at the area of telangiectatic vessels aiming to cause regression of these vessels. The laser therapy was given in four sessions within 3 months.\nAt 3-month follow-up after initial presentation, the exudative retinal detachment was resolved with minimal reduction of subretinal exudates. Review at 14 months post-retinal laser photocoagulation showed a reduction of the subretinal exudates at the posterior pole (). There was regression of the size of the retinal macrocyst with reduction of subretinal exudates surrounding the retinal macrocyst at 2 years post-retinal laser photocoagulation (). His right visual acuity was improved to 1/60, with no further improvement due to persistent dense and calcified subretinal exudates at the fovea.