Echographic diagnosis of advanced coats' disease

SUMMARY Standardised echography was utilised to diagnose two cases of advanced Coats' disease. The characteristic acoustic features included extensive, poorly mobile ret­ inal detachment; dense, dispersed subretinal opacities; looping of peripheral retina and absence of solid mass lesion and calcification. As enucleation of two eyes was necessary, it has proved possible to correlate the echo­ graphic and histological findings of this disease. The echographic features of other common causes of leuko­ coria are also discussed. Coats' disease constitutes one of the important causes of leukocoria. In young children early stages of the disease may be missed mainly due to the lack of presenting symp­ toms. When suspected, as in cases of squint, the diagnosis can easily be reached clinically, by observing the distin­ guishing retinal telangiectases and associated exudates. As the disease progresses, continuous deposition of sub­ retinal lipids, fibrin and phagocytes produces extensive 'exudative' retinal detachment, and the common sequelae of uveitis and rise of intraocular pressure, bringing the disease to the notice of parents and health personnel. The differential diagnosis of advanced Coats' disease, particularly against retinoblastoma, can be extremely dif­ ficult and usually requires the summation of various diag­ nostic aids, in addition to detailed and thorough clinical examination, before reaching the correct diagnosis and undertaking the appropriate course of action. If detected and treated at an early stage, useful vision may be pre­ served and secondary complications and eventual loss of the eye may be prevented. 2 Ultrasonography (echography) with its safety, sensitiv­ ity and unique ability of 'tissue differentiation ,3 is ideally suited for the investigation of children with Coats' disease and other 'leukocoric' conditions. Two cases of children with advanced Coats' disease are presented and the characteristic echographic features are described. As enucleation of the two eyes was necessary , it