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ONE MINUTE OPHTHALMOLOGY
Year : 2021  |  Volume : 69  |  Issue : 3  |  Page : 487

Unilateral macular exudation


1 Resident, Narayana Nethralaya, Bangalore, Karnataka, India
2 Vitreo-Retinal Services, Narayana Nethralaya 2, Narayana Health City, Bangalore, Karnataka, India

Date of Web Publication17-Feb-2021

Correspondence Address:
Dr. Thirumalesh Mochi Basavaraj
Consultant-Vitreo-Retinal Services, Narayana Nethralaya 2, Narayana Health City, #258/A, Bommasandra Industrial Estate, Anekal Taluk, Hosur Road, Bangalore - 560 099, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2842_20

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How to cite this article:
Khanum A, Basavaraj TM. Unilateral macular exudation. Indian J Ophthalmol 2021;69:487

How to cite this URL:
Khanum A, Basavaraj TM. Unilateral macular exudation. Indian J Ophthalmol [serial online] 2021 [cited 2021 Feb 28];69:487. Available from: https://www.ijo.in/text.asp?2021/69/3/487/309396



A 32-year-old male came to the outpatient department for routine eye examination. He had no significant ocular or systemic history. His visual acuity was 6/6 for both eyes on Snellen's chart. Anterior segment examination was unremarkable. Fundus evaluation showed severe exudation and well defined saccular dilated vessels away from the macula [Figure 1]a. Optical coherence tomography angiography (OCTA) [Figure 1]b and Optical coherence tomography (OCT) [Figure 1]c was obtained.


  What will be your preferred line of treatment? Top


  1. Observation as the visual acuity is good
  2. Cryotherapy
  3. Transpupillary thermotherapy
  4. Intravitreal Anti-VEGF injection



  Finding Top


Fundus picture shows massive macular exudation involving fovea in U-shaped pattern. Inferotemporally telangiectatic and dilated vessels seen, away from macula with intraretinal edema. Optical Coherence Tomography Angiography (OCTA) shows telangiectatic vessels, aneurysms and saccular dilatation of blood vessels with adjacent webs of filigree-like capillaries in superficial capillary plexus. Optical Coherence Tomography (OCT) section from the lesion shows superficial dilated blood vessels present with perivascular exudation and massive lipid deposition.

Diagnosis: Adult Coats' disease Stage 2B

Correct Answer: C.) Transpupillary thermotherapy (TTT)


  Discussion Top


Remote foveal or macular exudation is seen associated with vasoproliferative tumours, retinal capillary hemangioblastomas, and Coats' disease. Apart from the characteristic clinical features, OCT, and Fundus Fluorescein Angiography (FFA) are valuable diagnostic tools. We incorporated OCTA, a new and non-invasive modality to assess the fovea and retina. Our goal of treatment was to obliterate the telangiectasia to halt exudation and progression of the disease. In Coats' disease, the classification often guides the treatment.[1] Undetected and untreated disease can worsen leading to various complications such as exudative retinal detachment, development of epiretinal membrane and foveal ischemia.[2] Cryotherapy was not considered as approximation of cryoprobe to telangiectatic vessels due to their posterior location was difficult. Anti-VEGFs play a role as adjunctive therapeutic modality.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shields JA, Shields CL, Honavar SG, Demirci H, Cater J. Classification and management of Coats disease: The 2000 proctor lecture. Am J Ophthalmol 2001;131:572-83.  Back to cited text no. 1
    
2.
Smithen LM, Brown GC, Brucker AJ, Yannuzzi LA, Klais CM, Spaide RF. Coats' disease diagnosed in adulthood. Ophthalmology 2005;112:1072-8.  Back to cited text no. 2
    


    Figures

  [Figure 1]



 

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