This lesion was found incidentally on examination
Questions and Answers
1. What is your diagnosis of this lesion? Answer: Leber's miliary aneurysm
2. What characteristic features of this disease led you to that diagnosis? Answer: There is a notable retinal vascular abnormality in the superior temporal quadrant consisting of telangectatic vessels and a small aneurysm, surrounded by localized yellow subretinal exudate. There is also notable vascular sheathing. The fluorescein angiogram shows early and persistant leakage as well capillary DROP out. In addition there is late hyperfluorescence in the macula consistent with clinically observed parafoveal telangectasia.
3. What is the natural history of this disease? Answer: Leber's miliary aneurysm represents an early form of Coats' disease and may progress over time.
4. What is the racial / ethnic prediliction for this disease? Answer: There is no racial / ethnic prediliction.
5. What treatment would you recommend to this patient with 20/20 vision? Answer: Conservative observation is probably the best approach at this time. Macula threatening exudate and early retinal detachment may be treated by photocoagulation. Large exudative detachments, however, may require drainage with laser and or cryotherapy.