A 3-year-old boy has a unilateral white pupillary reflex. Fundus shows massive yellowish subretinal exudation with multiple saccular telangiectatic dilations of the retinal vessels, mainly temporal to the macula. Ultrasonography shows an exudative detachment without calcification. The most likely diagnosis is:

• A Retinoblastoma
• B Persistent fetal vasculature
• C Coats disease ✓
• D Toxocariasis

Explanation

Coats disease is a unilateral idiopathic retinal telangiectasia of young boys producing massive lipid exudation and exudative retinal detachment that mimics retinoblastoma (pseudoglioma). The key discriminators are absence of calcification on ultrasound, absence of a discrete mass, and the characteristic bulbous aneurysmal vascular dilations. Treatment is ablation of telangiectatic areas with laser photocoagulation or cryotherapy. Retinoblastoma typically shows intrinsic calcification, and PFV shows a persistent hyaloid stalk rather than diffuse exudation.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.