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Figure 1 - Fundus Figure 2 - Peripheral telangiectasias Photos courtesy of: Carol L. Shields, M.D. Used with permission. Not to be reproduced.

A 7-year-old male child was referred for the management of retinal detachment in his right eye. On examination, his best corrected visual acuity was 20/20 in the left eye and 20/400 in the right eye, with a relative afferent pupillary defect. Anterior segment examination was normal in both eyes. Above is the fundus picture of the right eye and it was normal in the left eye.

1.	What is your most probable diagnosis?
	a -- Coats' disease
2.	The line of treatment would be:
	d -- cryotherapy and laser treatment
3.	The most important tool of investigation in this case is:
	c -- indirect ophthalmoscopy and fluorescein angiography (FFA)

Confluent sub-retinal and intra-retinal exudation and peripheral telangiectasias in the above case are suggestive of Coats' disease.  Retinoblastoma never presents with exudation.  Detailed indirect ophthalmoscopic examination is the key to its diagnosis.  Fluorescein angiography (FFA) further highlights telangiectasias.  B scan ultrasonography can help in ruling out any calcification, in suspicious cases.  Coats' disease is treated by laser or cryotherapy.

References:

1.  Shields JA, Shields CL, Honavar SG, et al.  Classification and management of Coats' disease.  the 2000 Proctor lecture.  Am J Ophthalmol 2001; 131:572-583.

2.  Sheilds JA, Shields CL.  Differentiation of Coats' disease and retinoblastoma.  J Pediatr Ophthalmol Strabismus 2001; 38:262-266.