Abstract
Purpose :
Macular telangiectasia type 2 (MacTel2) is characterized by bilateral perifoveal telangiectatic capillaries manifesting in the 5-6th decade. Subretinal neovascularization (SRN) infrequently complicates MacTel2 and is likely retinal in origin (Charbel Issa et al. Prog Retin Eye Res 2014). Few reports have described OCTA findings in proliferative MacTel2 (Villegas et al. Case Rep Ophth Med 2017, Zhang et al. Retina 2015) and is the purpose of this case report.
Methods :
A 56 year-old Hispanic female with a history of progressive vision decrease presented with MacTel2 complicated by SRN OS. Due to healthcare inaccessibility she was then lost to follow-up until 8 months later. 6mm and 3mm macular OCTA (AngioPlex©, Carl Zeiss Meditec) was performed at the initial and 8 month exams along with structural OCT. The superficial, deep, and avascular preset enface displays as well as a customized avascular display OS were analyzed.
Results :
Initial examination revealed perifoveal retinal opacity, mild crystalline deposits, and temporal pigmented plaques OU. Additionally, superior perifoveal grayish subretinal thickening was noted OS. Structural OCT imaging revealed central outer retinal atrophy with associated subfoveal atrophic clefts OU. Two hyperreflective deposits (SRN) were visible superior and nasal to the fovea OS. The superior SRN membrane was associated with minimal adjacent RPE hyperpigmentation and had no associated fluid. The nasal SRN membrane had questionable adjacent subfoveal SRF. OCTA revealed enlarged foveal avascular zones with irregular contour OU. Prominent dilated telangiectatic perifoveal capillaries, particularly temporally, were present OU. Custom avascular enface display OS revealed 2 SRN complexes superior and nasal to the fovea. Blunted venules of the retina were present overlying both SRN membranes and appeared to anastomosis with them. OCT findings 8 months later were unchanged OD. The nasal SRN membrane OS developed new, adjacent SRF although no morphologic change in the SRN membranes themselves were noted.
Conclusions :
OCTA is a non-invasive technology that provides depth-resolved, high resolution microvascular detail of perifoveal telangiectasia in patients with MacTel2. This revolutionary tool is useful in detecting, quantifying, and morphologically characterizing SRN membranes that may complicate MacTel2.
This abstract was presented at the 2019 ARVO Imaging in the Eye Conference, held in Vancouver, Canada, April 26-27, 2019.