Coat's disease
 

Coat's disease showing telangiectatic vessels and  exudatesin the peripheral retina. Although most commonly seen in diabetic retinopathy,  hard exudates in the macula may suggest the presence  of peripheral retinal vascular disorders such as Coat's,  von Hippel's tumour or  macroaneurysm.

In the examination, most cases of Coat's disease seen are of the less severe types in which there are peripheral features of  Coat's disease. The severe types of Coat's disease in  which there are leucocoria, strabismus and extensive exudative retinal  detachment may appear in other sections such as ocular motility examination. Most patients are of the young age and usually male but occasionally you may get older patients with adult-onset Coat's  disease. The macula shows hard exudate with oedema. The peripheral retina has telangiectatic and tortuous blood vessels (which  may be occluded by the exudates) with subretinal exudates. There may be exudative retinal detachment. Look for: absence of similar changes in the fellow eye (Coat's disease is usually an  unilateral condition)

Questions:

1. When can you see light bulb changes in Coat's disease?

Answer
This is seen with fluorescein angiography. The light bulb changes refers to the aneurysmal dilatations of the arterioles and venules (which appears as hyperfluorescence) in areas of non-perfusion (which appears hypofluorescence).

2. How would manage the condition?

Answer
The retinal problems are caused by the abnormal vessels which need to be obliterated. This can be achieved with laser photocoagulation or cryotherapy. However, recurrence may occur and the patient needs to be followed up at regular interval. Retinal detachment surgery may be needed in advanced cases.
 

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