Exudative Vitreoretinopathy With a Coats-Like Response in Poretti-Boltshauser Syndrome

Purpose: To report a unique case of retinal exudation consistent with a Coats-like response and associated with mutations in LAMA1, confirming the diagnosis of Poretti-Boltshauser syndrome. Methods: A case and its findings were analyzed. Results: A 24-year-old woman presented with mild peripheral avascularity, circumferential membranes at the edge of the vascularized retina, exudation, numerous vessels with aneurysmal changes, and inferior retinal elevation in both eyes. Molecular Vision Laboratory panel testing (Molecular Vision Laboratory Corp) found 2 variants in the LAMA1 gene, confirming a diagnosis of Poretti-Boltshauser syndrome. Treatment with bevacizumab and sub-Tenon triamcinolone provided no improvement. Eventually, scleral buckling with pars plana vitrectomy was performed, which reattached the retina but did not improve visual acuity. Conclusions: This report shows the importance of investigating for an underlying genetic disorder in young patients with atypical exudation and abnormal vasculature and the persistent progression and challenging treatment course of patients presenting with Poretti-Boltshauser syndrome.