Cystoid macular edema in a child.
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Case details : An 11‑year‑old Caucasianboy with a 9‑month history of blurred vision in his right eye (OD) was found to have cystoid macular edema (CME) OD that failed to respond to Nepafenac eye drops. Family and systemic history was unremarkable.Upon Referral, best corrected visual acuity(BCVA)was 20/25 OD and 20/20 in his left eye (OS). Anterior segment was quiet and intraocular pressure was 12mmHgineacheye (OU).Fundus examination of the left eye was normal. The right eye demonstrated tiny parafoveal pinpoint exudation and meticulous examination revealed subtle vascular misdirection with looping along the superonasal periphery]. There was no vitritis or retinitis

Findings
Fluorescein angiography demonstrated superonasal peripheral nonperfusion with tortuous looping vessels, telangiectasia , and light bulb microaneurysms. There was additional mild leakage in the inferonasal foveal region.Optical coherence tomography(OCT) confirmed the presence of intraretinal macular exudation and mild, non cystoid edema in the papillomacular bundle]..

Diagnosis
Coats disease Stage 2B.
These Findings were suggestive of Coats Disease stage 2B with parafoveal exudation, a relatively mild stage.

Discussion: Coats disease is an idiopathic retinal condition characterized by vascular telangiectasia, exudation, and subretinal fluid, mostly affecting young males. Meticulous peripheral fundus examination and confirmatory diagnostic testing with FFA are necessary due to its resemblance to other vascular and exudative retinopathies. This condition is classified into 5 stages based on clinical features of
(1) telangiectasia,
(2) exudation,
(3) subretinal fluid,
(4) glaucoma, and
(5) phthisis bulbi.

Management options:The patient was treated with laser photocoagulation to the telangiectasia and microaneurysms based on staging, including laser photocoagulation, cryotherapy, external drainage of retinal detachment, and, in advanced end‑stage, enucleation.

Outcomes reveal visual acuity ≥ 20/40 in stage 1 (100%), stage 2 (33%), stage 3 (20%), stage 4 (0%), and stage 5 (0%). Therefore, earlier detection of Coats disease at a less advanced stage would allow improved visual outcomes.
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