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Nikolas J. London, Marc Spirn; Intravitreal Bevacizumab for Macular Edema associated with Macular Telangiectasia. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4519.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the effect of vascular endothelial growth factor-A inhibition on visual acuity in patients with idiopathic macular telangiectasia type 2 (MacTel).
We performed a retrospective review of patients with MacTel who were treated with intravitreal bevacizumab at the Retina Service of the Wills Eye Institute. LogMAR best-corrected visual acuity was recorded for all follow-up visits.
Twenty-three eyes of 21 patients were identified. All patients had macular edema associated with MacTel type 2, without evidence of choroidal neovascularization. The average age at initiation of bevacizumab was 61 years (range 42 to 79), 8 of the 21 patients were women. Post-bevacizumab follow-up ranged from 1 to 36 months, with an average of 12.8 months. There was a wide range in the number of bevacizumab injections given, from 1 to 10 (average 2.6). The change in visual acuity was calculated for all patients with data at each timepoint. The average baseline visual acuity was 20/80, (logMAR 0.57), improving to 20/60 (0.49) at month 1 (p = 0.20), 20/60 (0.44) at month 3 (p = 0.07), 20/60 (0.46) at month 6 (p = 0.35), 20/50 (0.39) at month 12 (p = 0.07), and 20/100 (0.71) at month 24 (p = 0.55). Overall, 11/23 eyes showed any improvement in visual acuity after the initial injection, whereas 6/23 eyes worsened, and 6/23 eyes showed no change. Five of the 11 eyes with any improvement in acuity had at least a doubling of the visual angle, and a single patient improved from 20/400 to 20/50 after one injection.
Intravitreal bevacizumab for macular edema associated with nonproliferative MacTel appears to have a variable effect on visual acuity. While 11 of our 23 eyes showed improvement, at no timepoint was there a statistically significant improvement. Future directions will include evaluation of changes in both fluorescein angiography and optical coherence tomography in our cohort, with particular attention to differences between bevacizumab-responders and non-responders. Our hope is to identify the characteristics of MacTel patients who may benefit from anti-VEGF therapy.
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