Coats’ disease

• A retinal vasculopathy
• M>F
• Idiopathic, non-hereditary
• Breakdown of the inner blood-retinal barrier in the endothelial cells
• Leakage of blood products, cholesterol crystals and lipid-laden macrophages into the retina and subretinal space
• Onset typically 6-8 years old
• 80% unilateral
• May co-occur with retinitis pigmentosa

Stages

1. abnormal vascular dilation
2. telangiectasia and yellowish exudation
3. exudative RD
4. total RD
5. irreversible blindness (complications: neovascular glaucoma, uveitis, phthisis bulbi)

Tests

• FFA: dilated/aneurysmal vessels, leakage, telangiectasias
• OCT
• Ultrasound
• Always exclude retinoblastoma (CT scanning may be helpful to reveal calcifications)

Management:

• Conservative: observation in mild, non-sight-threatening disease
• Laser photocoagulation and/or cryotherapy for telangiectasia
• VR surgery

MacTel

MacTel 1	MacTel 2 (most common)
Unilateral	Bilateral
Males	Middle aged men and women
Macular oedema	Retinal atrophy and subretinal neovasc
Congenital	Acquired
Telangiectatic capillaries and aneurysmal dilations are easily seen on slit-lamp	Telangiectasias are harder to see. Golden crystals and pigmented plaques may occur