CLINICAL FEATURES OF TREATED AND UNTREATED TYPE 1 IDIOPATHIC MACULAR TELANGIECTASIA WITHOUT THE OCCURRENCE OF SECONDARY CHOROIDAL NEOVASCULARIZATION FOLLOWED FOR 2 YEARS IN JAPANESE PATIENTS

Abstract

Purpose: To evaluate the clinical features of Type 1 idiopathic macular telangiectasia (IMT) followed up for 2 years.

Methods: Forty-nine patients with unilateral Type 1 IMT were examined. Thirty-one IMT eyes were treated with direct laser photocoagulation and/or intravitreal bevacizumab; the remaining 18 eyes, with good vision or slight macular edema, were untreated. Changes in best-corrected visual acuity and central retinal thickness between baseline and 24 months after the initial visit were examined.

Results: Of 49 eyes, nine were treated with direct laser photocoagulation, 12 with laser photocoagulation and intravitreal bevacizumab, 10 with intravitreal bevacizumab monotherapy, whereas 18 did not receive any treatment. The mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.20 ± 0.19 (median, 20/29) and 0.13 ± 0.22 (median, 20/25) at baseline and 24 months, respectively (P = 0.023). The mean central retinal thickness was 375.0 ± 94.5 μm and 315.3 ± 78.5 μm at baseline and 24 months, respectively (P < 0.001). Retinal vein occlusion and retinal macroaneurysm occurred in six eyes and one eye, respectively, during follow-up.

Conclusion: Treatment with laser photocoagulation and/or intravitreal bevacizumab may be effective for Type 1 IMT, 36.7% of IMT eyes required no treatment over a 2-year follow-up, and other retinal vascular events were not uncommon.

Fig. 1.

Box plot of logMAR VA of Type 1 IMT eyes according to the treatment option at baseline and 24 months. In each treatment option for Type 1 IMT, mean logMAR VA is not significantly improved at 24 months. The mean is the horizontal line, the boxes are the first/third quartiles, and the bars are the standard error of the mean. NS, not significant.

Fig. 2.

Box plot of CRT according to treatment option at baseline and 24 months. The CRT of Type 1 IMT eyes treated with IVB and LP with IVB is significantly reduced at 24 months. The mean is the horizontal line, the boxes are the first/third quartiles, and the bars are the standard error of the mean. ∗indicates P < 0.05, NS, not significant.

Fig. 3.

Case 1. A 68-year-old man with Type 1 IMT in his right eye treated with LP monotherapy. Color fundus photograph shows multiple MAs and retinal edema with hard exudates at the center of the macular area (A). Early-phase fluorescein angiography reveals parafoveal ectatic capillaries and MAs (B). Horizontal scan image of optical coherence tomography images at baseline show retinal thickening and cystoid spaces in the macular area (C). Optical coherence tomography image at 24 months shows that the intraretinal cystoid was reduced (D).

Fig. 4.

Case 2. A 72-year-old woman with Type 1 IMT in her right eye treated with IVB followed by laser photocoagulation. Early-phase fluorescein angiography shows ectatic parafoveal capillary vessels and MAs (arrows) (A). Late-phase fluorescein angiography reveals late leakage (B). Optical coherence tomography image at baseline shows cystoid macular edema (C). Optical coherence tomography image at 24 months shows that the intraretinal cystoid has disappeared (D). Color fundus photograph reveals the occurrence of branch retinal vein occlusion at 24 months (E).

Fig. 5.

Case 3. An 82-year-old man with Type 1 idiopathic macular telangiectasia in his left eye received no treatment. Color fundus photograph shows a reddish MA (arrow) and retinal edema at the center of the macular area (A). Early-phase fluorescein angiography reveals a parafoveal MA (arrow) (B). Horizontal scan image of optical coherence tomography image at baseline shows retinal thickening and cystoid spaces in the macular area (C). Color fundus photograph reveals a whitish MA (arrow) at 24 months (D). Optical coherence tomography image at 24 months shows that the macular edema reduced naturally (E).