Telangiectatic capillaries remodel over time in eyes with persistent diabetic macular edema

To study telangiectatic capillaries (TelCaps) in the context of diabetic macular edema (DME) and the response to injection therapy.

A retrospective analysis of 25 eyes with center involving DME that had TelCaps diagnosed on infrared reflectance (IR) and optical coherence tomography (OCT) B-scans with at least one year of follow-up. The size of the TelCaps was assessed on OCT IR and B-scans. The main outcome measures were the change in visual acuity (VA), central subfield thickness (CST), OCT biomarkers of DME, and size and number of TelCaps.

Compared to baseline, at 1 year and final follow-up (mean 44 months), the mean logMAR VA changed from 0.23 to 0.26 and 0.34, respectively (p = 0.296 and 0.139), and the mean CST changed from 325 μm to 348 μm and 355 μm, respectively (p = 0.172 and 0.098). 72% of the eyes had unchanged or worse VA and 64% had increased CST on final follow-up. The mean number of TelCaps per eye decreased from 1.36 at baseline to 1.12 at 1 year and 0.76 at the final follow-up (p = 0.04), with disappearance in 11 eyes (44%), and new TelCaps appearing in 3 eyes (12%). The mean size of the TelCaps was also significantly reduced at 1-year and final follow-up on both OCT IR images and B-scans.

Visualized on OCT B-scans and IR, TelCaps are dynamic structures that undergo significant remodeling over time. Eyes with DME and TelCaps treated with injection therapy of anti-VEGF or steroids after at least one year exhibited persistent DME despite a decrease in number and size of TelCaps. TelCaps may serve as a potential biomarker for chronic DME.