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Saira Khanna, John Moir, Shivam Amin, Lincoln T Shaw, David Dao, Nathalie Massamba, Rahul Komati, Dimitra Skondra; Utility of OCT-Angiography in Diagnosis and Management of Atypical Presentations of Macular Telangiectasia Type 2. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2948 – F0101.
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© ARVO (1962-2015); The Authors (2016-present)
Idiopathic macular telangiectasia type 2 (MacTel) is a retinal disease characterized by bilateral, asymmetric telangiectatic changes. These findings are often missed or misdiagnosed on optical coherence tomography (OCT) alone especially in the early stages, and fluorescein angiography is an invasive imaging technique. The purpose of this case series is to highlight the use of optical coherence tomography angiography (OCTA) as a non-invasive imaging modality to distinguish early or atypical MacTel from other macular conditions with similar presentations and its utility for longitudinal follow-up.
Retrospective chart review performed at the University of Chicago from 07/2017-07/2021. Participants included in this study were those diagnosed with MacTel based on clinical examination and imaging criteria on OCTA (Optovue RTVue XR Avanti (Optovue Inc, Fremont, California, USA 2018.1.8.60)).
15 eyes from eight patients were included in this study. The average follow-up time was 13.6 ± 10.2 months. Six patients were referred with previous diagnoses of macular hole, vitreomacular traction, cystoid macular edema, or diabetic macular edema. OCTA revealed telangiectatic vessels in the parafovea of the deep capillary plexus (DCP), cavitary changes, and ellipsoid zone (EZ) disruption in all 15 eyes. Internal limiting membrane draping was observed in 60% of eyes (n=9), while right-angled vessel branching was observed in 33% of eyes (n=5). OCTA highlighted subretinal neovascularization in 46.67% eyes (n=7). 2 of these eyes (28.6%) were treated with an anti-VEGF injection with improvement in VA, while the other 5 eyes (71.4%) were observed over the entirety of the follow-up period. Finally, one patient with a concurrent macular hole was treated with drop regimen with improvement in VA. At follow-up, VA of eyes was stable or improved with appropriate treatment.
OCTA is an imaging modality that is uniquely suited to detect and facilitate the diagnosis and longitudinal follow up of MacTel. Its repeated B-scans capture neurodegenerative changes in MacTel, while its en face angiograms display characteristic vascular patterns or CNV earlier in disease course than OCT, without needing to use invasive FA. Early diagnosis of MacTel with OCTA can be beneficial in guiding appropriate treatment and treating coexisting diseases to prevent future, irreversible vision loss.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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