First Author: H.Guler TURKEY
Co Author(s): T. Ogurel K. Ornek N. Ornek
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We present a case of a 31 year old female with unilateral massive macular exudation together with retinal angiomatous proliferation (RAP) and peripheral retinal vascular dilatations (aneurysmal and telenjectatic) compatible with adult onset Coats' disease.
Full ophthalmological examination, optical coherence tomography (OCT) (Retinascan Advanced RS-3000; NIDEK, Japan) imaging, fundus fluorescein angiography (FFA) (Canon Inc.,Tokyo, Japan) was performed.
The patient was presented to the ophthalmology outpatient clinic with compaints of low vision in her left eye for several months. The best corrected visual acuity was counting fingers from 2 meters in the left eye and 20/20 in the right eye. Fundoscopy of the left eye demonstrated massive macular exudation with gray colour of central macula and vascular dilatations with surrounding exudation in temporal mid peripheral retina. Retinal angiomamatous proliferation (RAP) (type 3 neovascularization) making shadow on fibrovascular pigment epithelial detachment which has internal hyperreflectivity and underlying intact Bruch membrane, cystoid macular oedema and lipid exudation was observed with spectal domain OCT in the left eye. Early phase of FFA showed small dense hyperfloresans with perfusing retinal arteriole and draining venule which was compatible with RAP. There was increased hyperfloresans caused by fibrovascular PED and hyperfloresans filling of surrounding cystoid spaces in late phase of FFA.
After 3 doses of intravitreal ranibizumab injected monthly and argon laser photocoagulation performed on the temporal aneurysms and telangiectasia, there was no macular oedema, minimal lipid exudation and central macular fibrosis. The best corrected visual acuity was counting fingers from 4 meters in the left eye and FFA and OCT demonstrated no active lesion.
Retinal angiomatous proliferation with fibrovascular pigment epithelial detachment may be a feature of adult onset Coats' disease which may heal with macular fibrosis and may be a predictor of poor visual outcome.