Intravitreal ranibizumab and laser photocoagulation in the management of idiopathic juxtafoveolar retinal telangiectasia type 1: a case report

Abstract

Background: Idiopathic juxtafoveolar retinal telangiectasia (IJRT) type 1 represents an uncommon cause of congenital unilateral visual loss and it typically affects males. Decrease in visual acuity is caused by serous and lipid exudation into the fovea with cystoid macular edema. In some cases, spontaneous resolution may be observed, but when there is a progressive loss of visual acuity, laser photocoagulation is often necessary. This treatment is not always successful and therapy for this condition is still controversial.

Case presentation: A 57-year-old man referred a 2-month history of blurred and distorted vision in the right eye. Best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination showed temporal macular edema, confirmed by optical coherence tomography. Fluorescein angiography showed a localized area of hyperfluorescence probably due to telangiectasia type 1 located below the inferior temporal area of the fovea. A combined therapy of intravitreal ranibizumab injection and laser photocoagulation was performed. Visual acuity improved from 20/50 to 20/32 and the therapy was well tolerated by the patient. After 3 years of follow-up, both visual acuity and fundus examination were stable.

Conclusions: This case suggests that the combined use of ranibizumab and laser photocoagulation may be considered an effective treatment for JRT type 1, leading to an improvement in both visual acuity and macular edema. We believe that intravitreal ranibizumab injection associated with laser photocoagulation should be considered as treatment for IJRT type 1.

Keywords: Idiopathic juxtafoveolar retinal telangiectasia; Intravitreal injection; Laser photocoagulation; Ranibizumab.

Fig. 1

Pre- and post-treatment OCT of the RE. The upper panel shows an increase of retinal thickness temporally to the macula and an alteration of the choriocapillary pigment epithelium barrier. The lower panel shows reduction of the macular edema with persistence of an alteration of the choriocapillary pigment epithelium barrier.

Fig. 2

Pre- and post-treatment FA of the RE. Upper panels: early and late frames showing leakage of juxtafoveal capillaries. Lower panels: early and late frames showing a hypofluorescent area corresponding to laser treatment and dye staining in the inferior temporal macular area.

Fig. 3

Automated computerized perimetry of the RE pre- and post-treatment. The left panel shows the visual field of the RE revealing a defect in the superior nasal field. The right panel shows a visual field within normal limits.