Long-term course in type 2 idiopathic macular telangiectasia

To study the long-term course in patients with idiopathic macular telangiectasia and report the effect of anti VEGF and laser treatment.

A retrospective case series of 19 patients/38 eyes with symptomatic type 2 idiopathic macular telangiectasia was performed. Six eyes received intravitreal injections of bevacizumab (1–3 injections), four eyes received focal laser treatment. Follow up examinations comprised visual acuity, biomicroscopy, fluorescein angiography and assessment of macular morphology and thickness by time and spectral-domain optical coherence tomography (OCT).

Mean follow-up time was 81 months (range 15–188 months) – the median added up to 80 months. Visual outcome at final visit varied substantially (20/200–20/20). On average visual acuity decreased 1,2 lines (range −0,5 to 6) by 3 years, 2 lines (range −0,5 to 7) by 5 years and 4,1 lines (range 0 to 12) by 10 years. Development of choroidal neovascularisation was observed in only one eye. There was no significant difference in visual acuity between eyes receiving no treatment, intravitreal bevacizumab or laser treatment after 3 and 5 years. Morphological studies by OCT revealed typical changes with retinal atrophy and intraretinal cysts. Visual acuity correlated with the eccentricity of the main manifestation–visual preservation was associated with mainly extrafoveal disease manifestation.

Type 2 idiopathic macular telangiectasia is a chronic, often slowly progressing macular disease leading to retinal atrophy and visual impairment over decades. Thorough knowledge about the long term course of this disease is necessary to evaluate possible therapeutic options in the long run.