Fig. 3

Case 3. Fovea-involving peripheral Coats disease in an 11-year-old boy who slept in the nasal-down position (inset 1). A A color fundus image when the visual acuity (VA) was 20/100 shows extensive temporal peripheral exudation invading the fovea. A spectral-domain optical coherence tomography (SD-OCT) image shows the intraretinal and subfoveal hyperreflectivity of the heavy exudation. B Eight weeks after the patient changed his sleep position (inset 2), followed by a series of laser treatments and intraocular anti-vascular endothelial growth factor (VEGF) injections, partial resolution of the exudation is confirmed by SD-OCT. The VA improved to 20/40. C Three months after the first presentation, the exudation is almost completely resolved. The VA was 20/25. D After 3 months, a new episode of foveal invasion with pooling of concentrated exudates is seen; the VA was 20/150 when the patient was not sleeping in the lateral-down position (inset 3). E He was lost to follow-up for 4 to 6 months and returned again with heavy foveal exudation; the VA was 20/200. F Six months after the sleep position was adjusted (inset 4), complementary laser, and monthly anti-VEGF injections, the exudation and vision improved to 20/30