Full-Thickness Macular Hole with Coats Disease
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A 17-year-old boy complained of blurred vision in his left eye. Best-corrected visual acuity (BCVA) was 20/20 in both eyes. On fundus examination, the right eye was normal and the left eye had a large area of yellowish subretinal exudate with overlying telangiectatic retinal vessels in the temporal periphery. Fluorescein angiography revealed diffuse temporal peripheral vascular leakage and staining corresponding to retinal aneurysms.

Optical coherence tomography (OCT) showed retinal deposits, highly indicative of internal limiting membrane (ILM), and no sign of exudate. These clinical features led to a diagnosis of stage 2A Coats disease. Argon laser photocoagulation (PC) was performed for the temporal aneurysms, a total of 3 times, following which the subretinal exudate improved. This patient visited the United States to study and there he received intravitreal anti-vascular endothelial growth factor (VEGF) injection twice. At 30 months after the first visit, BCVA in his left eye declined to 20/50. Tensioned ILM, serous macular detachment (SMD) and retinal thinning was confirmed on OCT.

The fundus examination showed that the intraretinal exudate was still present in the left eye. We performed additional PC and 36 months after the first visit, BCVA in his left eye further declined to 20/63. OCT revealed FTMH. The horizontal diameter of the macular hole was 262 ?m. We then performed 27-gauge pars plana vitrectomy. There was no posterior vitreous detachment, and so we created it surgically. ILM peeling was performed using Brilliant Blue-G dye (0.06%). Additional PC was performed for the peripheral retinal aneurysms. This was followed by tamponade with 20% sulfur hexafluoride gas. The patient was advised to maintain a face-down position until the FTMH closed. One day later, the FTMH remained. Four days after vitrectomy, the FTMH was found to be closed. OCT 1 month after vitrectomy showed SMD, but the FTMH remained closed (Fig. 3b). Follow-up at 6 months revealed that the subretinal exudate had gradually disappeared. BCVA improved to 20/20 and SMD decreased. Postoperatively, there was no progression of cataract and recurrence of intraocular inflammation during the 24 months of the follow-up period.

Source: https://www.karger.com/Article/FullText/508821
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