Coats' disease has a much more dramatic appearance, ranging from mild exudation to massive aneurysmal exudation and exudative retinal detachment. The formation of retinal telangiectasia and breakdown of the inner blood-retinal barrier are the fundamental causes of all changes found in Coats' disease. Due to capillary closure at the telangiectasia, retinal neovascularization with subsequent vitreous hemorrhage and tractional retinal detachment can also occur. Untreated, there will be gradual progression to total exudative retinal detachment. The prognosis for Coats' disease is guarded.
Treatment is laser photocoagulation or cryoretinopexy for thermal necrosis of the abnormal vessels.
In cases of retinal detachment, scleral buckle procedures are employed. In extreme cases where blindness ensues, pain relief is indicated. Obtain retinal consultation for Leber's miliary aneurysm. You may also need to have the unleaking vessels thermally obliterated before significant leakage and exudation occurs. Clinical Pearls One quarter of cases of Coats' disease are discovered in asymptomatic patients during routine examination.