A Case of Anterior Chamber Cholesterolosis Due to Coats' Disease and a Review of Reported Cases

Unusual anterior and posterior segment features of coats disease

PURPOSE

To report the clinical course and management of unusual anterior and posterior segment features of Coats disease and their relation to the age of the patients to increase the awareness towards these rare clinical features rarely described in the current literature.

METHODS

A retrospective descriptive review of 45 eyes of 45 patients affected by Coats disease was conducted at the Retinoblastoma Referral Center and Ophthalmology Unit of the University of Siena in Italy analyzing data from 2000 to 2022. Medical records and images were revised to find some cases presenting unusual anterior and posterior segment features in patients affected by Coats disease.We identified therefore 4 unusual clinical conditions: retinal macrocysts, anterior chamber cholesterolosis, fovea-sparing Coats disease and secondary vasoproliferative tumor.

RESULTS

Two patients presented with retinal macrocyst (2/45  =  4.4%), one with anterior chamber cholesterolosis (1/45  =  2.2%), two with fovea sparing Coats disease (2/45  =  4.4%) and one with vasoproliferative tumor associated (1/45  =  2.2%) for a total of six (6/45  =  13.3%) patients manifesting unusual anterior or posterior segment features in Coats disease.

CONCLUSION

Unusual anterior and posterior segment features of Coats disease such as retinal macrocyst and anterior chamber cholesterolosis have been more frequently reported in younger children while fovea-sparing and vasoproliferative tumors have been more commonly described in older patients. Age is then a strong prognostic marker which allows to distinguish two different phenotypes of Coats disease: patients younger and older than 3 years old with more aggressive and milder phenotype respectively.

A Rare Association: Neovascular Glaucoma Accompanying Anterior Chamber Synchysis Scintillans

Synchysis scintillans, also known as cholesterolosis bulbi, is a degenerative eye pathology characterized by the accumulation of cholesterol crystals in the vitreous. It is typically observed bilaterally but can rarely be unilateral. It can be triggered by severe trauma, chronic inflammation, chronic retinal detachment, hyphema, vitreous hemorrhage, Coats’ disease, and retinoblastoma. In this report, we present a case with an uncommon association of anterior chamber synchysis scintillans and neovascular glaucoma.

Bilateral anterior uveitis as a presenting feature of Juvenile Xanthogranuloma in a neonate

Purpose

To report a case of diffuse xanthogranuloma presenting as bilateral anterior uveitis in a neonate.

Observations

A neonate was brought by the parents with complaints of redness, watering, and photophobia in both eyes for 10 days. Examination under anesthesia revealed the presence of bilateral hyphema, fibrinous membrane, corneal haze, and raised intraocular pressure (IOP). Ultrasound Biomicroscopy revealed diffuse bilateral iris thickening. The child was managed medically with topical glaucoma medications, topical steroids, and cycloplegics. The child responded well with the resolution of hyphema, anterior chamber inflammation, and reduction of IOP.

Conclusion and importance

In neonates and infants presenting with bilateral uveitis, spontaneous hyphema, and secondary glaucoma, even in the absence of a well-defined iris lesion, diffuse juvenile xanthogranuloma should be considered as a differential diagnosis.

Ultrasound findings in a case of Eales' disease and ocular trauma with anterior chamber cholesterolosis

Background

Anterior chamber cholesterolosis is a rare phenomenon which occurs mostly in chronically blind eyes. We present the anterior and posterior ultrasound findings in a case of anterior chamber cholesterolosis secondary to Eales’ disease and ocular trauma, which may contribute to the understanding of the potential mechanism of this phenomenon.

Case presentation

A 48-year-old man presented with “sparking” right eye, which appeared soon after the ocular trauma. Both eyes were confirmed Eales’ disease in our center 8 years ago, and right eye remained no light perception since then. Intraocular pressure of right eye measured by Goldmann applanation tonometry was 1 mmHg. Slitlamp photograph revealed multiple polychromatic large crystals in anterior chamber. Ultrasound biomicroscopy showed that anterior chamber was filled with extensive large granular substances. Dense dotted hyperechoic foci and retinal detachment was found in B-scan ultrasound examination. The right eye was diagnosed as anterior chamber cholesterolosis secondary to Eales’ disease and ocular trauma. The patient was asymptomatic, and therefore was advised to have regular follow-up.

Conclusion

The findings of above imaging examinations, as well as complaint of “sparkling” eye appeared soon after ocular trauma elucidate that anterior chamber cholesterol crystals were from vitreous cavity. Any factors facilitating the communication of anterior chamber and vitreous body may lead to the occurrence of this rare phenomenon in predisposing eyes. The anterior and posterior ultrasound findings may give a clue on the potential mechanism.

Recent advances in the diagnosis and treatment of Coats' disease

PURPOSE

To review and summarize the recent progress in the diagnosis and treatment of Coats' disease.

METHODS

Literature was collected from Web of Science, Medline and Pubmed, through searching of these keywords: "Coats' disease", "diagnosis" and "treatment".

RESULTS

Coats' disease is characterized by idiopathic leaky retinal vascular telangiectasia and microvascular abnormalities often accompanied by intraretinal or subretinal exudation and retinal detachment. Neovascular glaucoma and phthisis bulbi often occur in advanced cases. Coats' disease has significant diversity in terms of its clinical presentation and morphology. Anti-VEGF therapy combined with laser photocoagulation for early Coats' disease and anti-VEGF therapy combined with minimally invasive vitrectomy for advanced Coats' disease can achieve good efficacy.

CONCLUSION

Early diagnosis and timely treatment based on clinical stage are critical to retaining the patient's visual function. Patients should be aware that close long-term follow-up is necessary.