Treatment Modalities for Idiopathic Macular Telangiectasia: An Evidence-Based Systematic Review of the Literature

Abstract

Purpose: The purpose of this systematic review was to stratify the literature on the therapeutic approaches for macular telangiectasia (Mactel type 1 and 2) to provide evidenced-based practical guidelines for the optimal standard care of these conditions.

Methods: A comprehensive search of PubMed was performed using a specific search algorithm. All articles retrieved were carefully screened and their references were manually reviewed for additional relevant data. Level of evidence was provided for each treatment modality, graded as level I, II, III, IV, and V, and indicative of very strong, strong, substantial, relatively weak, and weak evidence, respectively.

Results: 1445 abstracts were checked and 123 were found to be relevant. Out of them, 102 were eligible for the purpose of our review and 86 were focused on treatment of macular telangiectasia. Most publications combined cases of Mactel type 1 and type 2, despite their distinct pathophysiology. In Mactel type 1, laser photocoagulation of the telangiectasia remains the mainstay in controlling macular edema, while anti-vascular endothelial growth factor (anti-VEGF) agents provide short-term benefits. In Mactel type 2, current treatment options are not effective in the management of the non-proliferative stage, while anti-VEGF agents seem to be effective in the treatment of choroidal neovascularization complicating the disease.

Conclusion: It is important to differentiate the type of macular telangiectasia to plan appropriate treatment.

Keywords: Anti-VEGF; Mactel; corticosteroids; laser; photodynamic; telangiectasia; treatment.