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Sharad Malavade, Steven Cohen; Optimal treatment strategy for Stage 5 Type 2A Idiopathic Macular Telangiectasia with anti-vascular endothelial growth factor (VEGF) agents - When to stop?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4930. doi: https://doi.org/.
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To evaluate long term follow-up of patients with Stage 5 (neovascular) Type 2A idiopathic macular telangiectasia treated with anti-vascular endothelial growth factor (VEGF) agents.
Retrospective review of three cases treated with bevacizumab and subsequently followed for an average 45 months (range 26 months - 61 months). The charts were reviewed to determine presenting symptoms, the baseline visual acuity at time of diagnosis of subretinal neovascular membrane (SRNVM), initial series of treatments with intra-vitreal bevacizumab injections, period of quiescence, recurrence and repeat therapy.
All patients presented with acute vision loss. The average age was 71 years (range 60 years - 78 years) at time of presentation. The average Snellen visual acuity was 20/125 (range 20/50 to 20/200). Signs of neovascularization included pigment epithelial detachment, subretinal fluid and subretinal hemorrhage. Following treatment with intravitreal bevacizumab, each patient’s presenting symptoms abated and the average visual acuity improved to 20/63 (range 20/50 to 20/160). The treatment was stopped when the macula became dry and stable following a treat and extend treatment strategy. In all three patients, recurrent SRNVM was noted after a mean period of 22 months (range 6 months - 41 months) of their last injection. At recurrence, each eye developed similar signs and symptoms to the initial episode. The patients have all responded to re-institution of intravitreal bevacizumab.
It may not be safe to discontinue intravitreal injection of anti-VEFG agents in eyes of patients with neovascular Type 2A macular telangiectasia. Time to recurrence varied from 6 months to 41 months. The optimal treatment strategy for patients with stage 5 Type 2A macular telangiectasia is not known.
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