NEWS & EVENTS
Retinal Review, Issue 47
Authored by Burton Wisotsky, M.D.
A 9 year old boy was referred for vision loss in his left eye. He was noted to have a “wandering eye” by his parents. He was evaluated by his optometrist and noted to have leukocoria. He was subsequently referred for retinal evaluation. Past medical history is unremarkable. There is no family history of significant ocular issues. On examination VA measured OD: 20/20 and OS: CF. IOP’s were normal. A constant left exotropia was present. Moderate leukocoria was present on external examination. A left afferent papillary defect was noted. Dilated examination of the right eye was normal. In the left eye there was an early posterior subcapsular cataract. The vitreous was moderately hazy. The fundus examination for both eyes is shown below, as is the bscan of the left eye:
The differential diagnosis for leukocoria includes congenital cataract, vitreous opacity, retinopathy of prematurity, retinoblastoma, persistent hyperplastic primary vitreous, congenital toxoplasmosis, coloboma, and Coat’s disease. Our patient had monocular findings including extensive macular and peripheral lipid, macular fibrotic scar, peripheral intraretinal aneurysms, and localized retinal detachment with large cyst. The bscan confirmed the cystic nature of the fluid in the left retina. The findings were consistent with Coat’s disease. Coat’s disease is most commonly found in childhood. It usually affects one eye, but occasionally both eyes are involved. The prognosis depends on when the disease is diagnosed. If caught early, the condition is treatable and excellent vision can be maintained. Coat’s disease is usually caught late because children do not typically complain about their vision. The disease is usually discovered either due to leukocoria or ocular deviation. By that time the retinal vasculopathy is usually advanced. The goal in treating our patient was maintaining a functioning eye with preservation of some vision. Restoring the eye to good vision was not possible. We explained that often multiple treatment sessions are necessary in Coat’s patients with extensive exudation. If there is exudation with a flat retina, the eye is often treated with a combination of laser and cryopexy. Because our patient was detached, he required a more invasive approach. He underwent a combination of sclera buckle, pars plana vitrectomy, endodrainage of the retinal detachment, and silicone oil placement. Post op VA was 20/400 and the retina was flat under the oil (see below). The family understands that it is likely that he will need additional surgical intervention, but it is also likely that he will maintain some degree of vision in his eye.
Dr. Burton Wisotsky
Dr. Danielle Strauss
Dr. George Veliky (Iselin office)
Dr. Mike Veliky (Rochelle Park office)
Dr. Allison Lafata (West Orange office)
Dr. Nazreen Esack (Parsippany office)
Dr. Katherine Mastrota (New York office)
Ann Lacey (Marketing Director)