Late Exudative Retinal Detachment in Prior Treated Retinoblastoma

An 18-year-old RB1-mutation carrier with a history of retinopathy of prematurity not requiring treatment and previously treated unilateral multifocal retinoblastoma re-presented after loss to follow-up with new peripheral vision loss. Imaging revealed an inferior exudative retinal detachment with telangiectasia, lipid exudation, and peripheral nonperfusion, without evidence of mass or calcification. Aqueous humor RB1 liquid biopsy was negative for tumor DNA. Exudation and hemorrhage initially worsened despite laser and anti-vascular endothelial growth factor therapy, but later showed partial improvement. Subsequent progression of cataract, posterior synechiae, and a bombe configuration without neovascularization suggested a Coats-like vascular response. No similar cases have been reported in the literature. Ongoing management includes intravitreal injections, selective laser, and close monitoring to distinguish vascular sequelae from recurrence.