Coats disease masquerading as retinoblastoma at Kenyatta National Hospital – a case series

Abstract

Aim: To describe 5 cases of coats disease that were referred as retinoblastoma to Kenyatta National Hospital

Study design: A retrospective case series.

Study location and period: Ophthalmology Eye Unit at Kenyatta National Hospital between June 2023 and September 2024. 

Methods: The files for patients who had been referred to Kenyatta National Hospital as retinoblastoma and turned out to be cases of coats disease were reviewed. Data collected included age, sex, presenting visual acuity, findings on fundus examination and other ancillary tests.

Results: The five cases presented were referred to Kenyatta national hospital with unilateral leukocoria and a tentative diagnosis of unilateral retinoblastoma. There were four males and one female, and all the children were less than three years of age. All the children had profound visual loss of the affected eye at presentation. The right eye was affected in three children and left eye in two children. Even though all of the patients had an initial diagnosis of retinoblastoma at presentation, further work up at Kenyatta National hospital ruled out retinoblastoma in four of them. However, the clinical diagnosis was not clear-cut for one patient and the diagnosis of retinoblastoma was upheld and enucleation of the affected eye done. The histology of the enucleated eye however showed features of coats disease. 

Conclusion: Coats disease is a rare ocular condition, and it is sometimes difficult to differentiate from retinoblastoma clinically. Proper work up however can pick most cases, and unnecessary enucleations can be avoided. Sometimes the diagnosis can only be confirmed histologically after enucleation.