Download to read offline
More Related Content
Similar to Coats Diseas e BY DR.PUSHKAR DHIR.pptx
More from DHIR EYE HOSPITAL
Coats Diseas e BY DR.PUSHKAR DHIR.pptx
- 1. Coats disease isan idiopathic condition characterized by telangiectatic and aneurysmal retinal vessels with intraretinal and subretinal exudation and fluid. By Pushkar . Moderated by Dr.Parvez
- 3. • George Coats1908 • IDIOPATHIC Telengiectatic & Aneurysmal Vessel. Exudative retinopathy due to Subretinal Fluid & Lipid Exudates. Most commonly seen unilaterally.(85%) • 3 times more often in Guys as compared to girls. (Fazil > Pooja) • Disease name solely on basis of Inventor. • Coats was once thought as tumour so loads of enucleation!!! !!!Idiopathic too has some reason!!! Mutation in CRBI gene. Norrin – a retinal protein. NDP xp11.2 gene
- 9. Q. What isthe difference between telangiectasia and aneurysms ? Pooja and mandabi pic
- 11. STAGE CRITERIA PREVAL ANCE 1(T) Retinal Telangiectasia (T) only 1% 2 (T+E) 2A (Extrafovea) Telengiectasia + Exudation 8% 2B (Foveal) Telengiectasia + Exudation 6% 3 ( T+ E+ D ) 3A1/ 3A2 3A 1:- Extrafoveal Detachment 3A2:- Foveal Detachment 19/19% 3B Total Retinal Detachment 30% 4( T+ E+ D+ G) Total Retinal Detachment & Glaucoma 15 % 5( T + E + D + G + P) Advanced stage with Pthisis Bulbi. 2%
- 12. FACTS ABOUT COAT’S •Painless • 3 times more often in Guys as compared to girls. • Unilateral 80-95%. • Vessels-? • Mean age at diagnosis 5 years to 63 years.!!! 1st and 2nd decades of life most common age at presentation (median age 5-8 years old), but can present at any age. Juvenile Onset Adult Onset • Smaller area of involvement. • Slower disease progression. • Frequent Haemorrhage • Associated with HYPERCHOLESTRIMIA
- 13. CLINICAL PRESENTATION • ChiefComplaints:- Decreased VA , Squint , Leukocoria, Xanthocoria (yellow pupil) , Pain , Hetrochromia , Nystagmus. • Anterior Chamber Findings :- 90% normal but 10 % has cataract , iris neovascularization , shallow AC , corneal odema , cholestrol crystal in AC, Megalocornea. • Retina Findings :- Telangiectasia (100%) , Intraretinal exudation (99%) , Exudative retinal detachment (81%) ,Retinal Haemorrhage (13%) , Retinal Macrocyst (11%) , Optic disc neovascularization (1%) NO EYES HAD VITREOUS HAEMORRHAGE.
- 14. STAGE 4 COATSDISEASE COATS is Localized ,yellow , subretinal exudation assocaited with adjacent vascular anomalies like sheathing , telngiectasia, tortousity, aneurysmal dilatation , zones of capillary drop out & occasionaly neovasularization
- 16. SEQUENTIAL PHOTOS POSTLASER TREATMENT
- 17. • Localized lipiddeposition and varying degrees of subneural retinal exudate . • Vessels may appear sheathed and telangiectatic. • Aneurysms are grape-like, clustered, or lightbulb shaped
- 18.
- 21. Sri Sankaradeva Nethralaya MALAK,A, 01.01.1964 - Patient no.: 170640350 - Operator: Colour 25.01.2018 OD Colour 25.01.2018 OS
- 22. • Most retinaltelangiectases are ACQUIRED SECONDARY to local or systemic conditions such as branch retinal vein occlusion and diabetic retinopathy. PRIMARY RETINAL TELANGIECTASIA IS FOUND IN • Coats’disease, • Leber’s miliary aneurysms (a localized, less severe form of Coats’disease), • Idiopathic juxtafoveal telangiectasia, and other angiomatous diseases Retinal telangiectasia is found in a wide range of ocular disease processes
- 24. DIAGNOSIS • IDO EXAMINATION •WIDEFIELD FUNDUS PHOTO / RETCAM • FFA/WIDEFIELD ANGIOGRAPHY • OCTA • USG • MRI/ CT • BLOOD TESTING
- 26. Numerous localizedanomalies of the retinal vasculature with peripheral retinal non- perfusion. Telangiectasia, aneurysms, beading of vessel walls, and various vascular communicating channels are found with larger vessels. These vessels show early and persistent leakage, leading to cloudy subretinal exudates which gravitate to posterior pole.
- 27. B-SCAN • Early stages:-Vertical macula B-scan shows localised dome-shaped exudative RD at the macula. • A-scan shows multipeaked spike from thickened retina and medium reflective spikes from SUBRETINAL CHOLESTEROL. • Longitudinal B-scan shows funnel-shaped RD and opacities from subretinal cholesterol.
- 28. CT FINDINGS DEPENDON THE STAGE OF DISEASE. Early :- Examination may be normal. Enhancement may be seen at the margins of the exudate and may have a V- shaped pattern similar to retinal detachment . Advanced :- Globe is hyperdense due to proteinaceous exudates and the vitreous space may be obliterated due to extensive retinal detachment. Calcification is uncommon but has been reported. The affected eye in Coats disease is usually significantly smaller than the non- affected eye in older children, and is thought to represent an impairment of growth rather than the reduction in volume of a previously normal globe.
- 29. • Optical coherencetomography (OCT) helps in quantitative documentation of retinal thickening. • Typical findings include • prominent intraretinal hyperreflective material that corresponds to hard exudate seen on examination and on color fundus photography; • Intraretinal cystoid edema; • Less commonly, subretinal fluid. • Hard exudates and cystoid edema are most prominent in the outer retina
- 30.
- 31.
- 32. Stage 1 disease(telangiectasia only): periodic observations or laser photocoagulation. Stage 2 disease (telangiectasia and exudation): Best managed by laser photocoagulation or cryotherapy, depending on the extent of the disease. Stage 3B disease (total RD): Can be managed with cryotherapy if the RD is shallow. May require an attempt at surgical reattachment if the RD is advanced and immediately posterior to the lens. Stage 4 disease ( total RD with glaucoma): Often needs enucleation for the severe ocular pain. Stage 5 disease: At this stage, patients have generally a blind, but comfortable eye and require no aggressive treatment.
- 33. Endstage cases associatedwith neovascular or angle closure glaucoma, or a blind painful eye may require enucleation.60,146 Alternatively, eyes with neovascular glaucoma may respond to transscleral diode laser cyclophotocoagulation
- 34. References & Acknowledgements •RYANS RETINA 7TH EDITION • EMR IMAGES FROM SANAKARDEVA NETHRALAYA • Google Images of Survey of ophthalmology • Thanks to Dr.Ronel Soibam Dept of Retina Sri Sankardeva Nethralaya
- 35. • THANK YOUEVERYONE FOR PATIENTLY LISTENING TO THIS PRESENTATION • For feedbacks & brickbats plz mail at • [email protected] D BEST WAY TO LEARN IS TO TEACH