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Ranjit Sandhu, Robin Hamilton; Treatment of proliferative idiopathic macular telangiectasia Type 2 with intravitreal bevacizumab. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4655.
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Idiopathic macular telangiectasia Type 2 is bilateral and characterised by retinal opacification, vascular telangiectasia, right-angled venules, intraretinal crystalline deposits, foveal thinning, retinal pigment epithelial hypertrophy and rarely, choroidal neovascularisation (proliferative form). The purpose of this study was to determine the effect of treatment with intravitreal bevacizumab on retinal thickness and visual acuity in the proliferative form of MacTel Type 2 in a small case series.
A retrospective review of clinical notes of patients with idiopathic macular telangiectasia Type 2 complicated by choroidal neovascularisation based on fundus fluorescein angiography who received treatment with intravitreal bevacizumab injections was carried out. All patients had Snellen visual acuity testing, fundus fluorescein angiography and optical coherence tomography (OCT) at baseline. The patients were treated until the choroidal neovascular membrane (CNV) showed no signs of activity based on the OCT findings. Visual acuity and central macular thickness were recorded at final follow-up visit.
Ten eyes of seven patients, of which two were males and eight females, were included. The average age was 60 years ± 5 years and the average follow-up was 14 months ± 12 months (range, 2-34 months). The visual acuity was 0.6 ± 0.5 logMAR at baseline and 0.6 logMAR ± 0.4 logMAR at final follow-up. The central macular thickness was 223µ ± 41µ at baseline and 229µ ± 53µ at final follow-up. The average number of bevacizumab injections administered were 3 (range, 1-8). There was no improvement in the visual acuity or central macular thickness. The CNV resolved in all ten eyes of seven patients. One patient did not require bevacizumab as the CNV regressed spontaneously.
Although the use of intravitreal bevacizumab in the proliferative form of idiopathic macular telangiectasia Type 2 did not improve the visual acuity or reduce the central macular thickness, it resulted in the regression of the CNV. As the probability of progression from absence to presence of an IS/OS PR break has been recently reported to be as high as 72% after 5 years by the MacTel Study group and CNV complicating MacTel posing a further threat to central visual loss, treatment with intravitreal bevacizumab prevents further visual loss in this potentially sight threatening condition.
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