Rare pediatric coexistence of combined hamartoma of the retina and retinal pigment epithelium and Coats' disease: Clinical course, imaging, and management.

PURPOSE: To report a rare pediatric case of juxtapapillary combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) with superimposed peripheral Coats lesions, highlighting multimodal imaging and stepwise management. METHODS: A 10-year-old boy with CHRRPE and peripheral Coats lesions was managed with targeted laser photocoagulation, followed by intravitreal anti-VEGF injection for persistent exudation. Multimodal imaging, including OCT, OCTA, and fluorescein angiography, guided diagnosis and treatment. RESULTS: Two-year follow-up demonstrated stable retinal lesions, preserved visual function, and absence of vitreoretinal traction or neovascular glaucoma. Multimodal imaging allowed differentiation of overlapping lesions and guided selective intervention. CONCLUSION: This case illustrates the importance of individualized, stepwise management in complex pediatric retinal disorders and the critical role of multimodal imaging in guiding treatment.