Paediatric Ophthalmology:
                        Case thirteen

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This eight-year old boy was referred by his optician because of a decreased right vision. The above picture shows the appearance of his right peripheral retina.

a. What does the picture show?

Telangiectatic retinal vessels with subretinal exudates.

b. What is the diagnosis?

Coat's disease.

This condition is non-inherited and typically presents in late childhood (average age of eight). It affects the males predominantly and is unilateral in 90% of cases. The visual loss is caused by the leaky peripheral telangiectatic vessels which give rise to retinal exudate which eventually affects the macula. The condition is painless and slowly progressive, consequently most patients present in advanced stage. Untreated the eye may develop exudative retinal detachment and neovascular glaucoma.

c. How would you treat this condition?

Treatment is directed at obliterating the abnormal vessels. This may be achieved with cryotherapy or laser photocoagulation.