A healthy 9-year-old male with no family history of vision problems presents after failing a vision screening test at baseball practice. The patient could not identify letters on the eye chart using his left eye. One year prior, the child was referred to an ophthalmologist after a school nurse identified poor vision in the left eye but the patient did not follow up. Ocular exam revealed leukocoria, light bulb aneurysms temporally, subretinal fibrosis with areas of exudation, and dilated telangiectatic vessels. What is the most likely diagnosis?
A. Retinopathy of prematurity
C. Vitreous hemorrhage
D. Coats disease
Answer: D, Coats Disease
Coats disease (exudative retinopathy) is a retinal vascular disorder characterized by retinal telangiectasia and subretinal exudates. It predominantly affects unilateral eyes of males between the ages of 5-9 years old and presents with a gradual loss of vision. Although choices A, B, and C may all present with leukocoria (abnormal white reflection from the pupil), these do not match the clinical presentation. Option A can be eliminated because retinopathy of prematurity affects preterm infants and typically does not progress to childhood after treatment. Retinoblastoma is not the correct choice because it most frequently affects younger individuals < 4 years old, and fundus findings would show a tumor/mass. Rb is also often bilateral and may present with strabismus and a painful, red eye. Although a vitreous hemorrhage is caused by the extravasation of blood in and around the vitreous, option C may be eliminated as this condition presents with sudden onset and floaters.
Source: Iowa Eye Rounds
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