Navigated laser treatment with preliminary anti-VEGF therapy in macular telangiectasia type 1

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Macular telangiectasia type 1 (MacTel1) is a rare condition characterized by multiple parafoveal microaneurysms, which leads to local nonperfusion, capillary ischemia, lipid and serous exudation which cause cystoid macular edema. Microaneurysms are detected by fluorescein angiography and optical coherence tomography-angiography. MacTel1 is relatively resistant to antiangiogenic therapy. Focal laser photocoagulation of microaneurysms is a pathogenetically substantiated treatment method. The use of navigation approach with topography-based planning allows increasing precision, safety and efficacy of laser effect. Clinical case. A 75-year-old patient with MacTel1, associated with a cystoid macular edema 702 µm. Treatment included intravitreal antiangiogenic therapy with consequent navigation targeted laser photocoagulation of microaneurysms. The best-corrected visual acuity and central retinal thickness were examined. After the combined treatment, best-corrected visual acuity increased from 0.3 to 0.9. OCT showed central retinal thickness reduction to 395 µm (∆307 µm). Fluorescein angiography showed decrease in the number and size of the microaneurysms, in the number of observed leakage points, in the intensity of the dye leakage. In the presented clinical case of MacTel1, the staged treatment approach including intravitreal antiangiogenic therapy with consequent navigation targeted laser photocoagulation of microaneurysms showed its effectiveness in reducing cystoid macular edema height and in improving visual functions.

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作者简介

Pavel Volodin

S. Fyodorov Eye Microsurgery Federal State Institution

Email: volodinpl@mntk.ru
ORCID iD: 0000-0003-1460-9960
SPIN 代码: 9296-0976

MD, Dr. Sci. (Medicine)

俄罗斯联邦, 59a Beskudnikovsii blvd, Moscow, 127486

Elena Ivanova

S. Fyodorov Eye Microsurgery Federal State Institution

Email: elena-mntk@yandex.ru
ORCID iD: 0000-0001-9044-3400
SPIN 代码: 5002-2460

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 59a Beskudnikovsii blvd, Moscow, 127486

Sofia Belianina

S. Fyodorov Eye Microsurgery Federal State Institution

编辑信件的主要联系方式.
Email: sofiabelyanina00@mail.ru
ORCID iD: 0000-0002-5982-9396
SPIN 代码: 6312-7830

MD

俄罗斯联邦, 59a Beskudnikovsii blvd, Moscow, 127486

参考

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2. Fig. 1. Photoregistration of the fundus on presentation: a, right eye, abnormal macular reflex, wrinkling of the macular surface; b, left eye, multiple microaneurysms in the parafovea, macular edema, para- and perifoveal “hard” exudates surround the area of macular edema. Initial OCT of the macular zone: c, right eye, epiretinal membrane, increased central retinal thickness; d, left eye, increased central retinal thickness, intraretinal cysts in the fovea, “hard” exudates

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3. Fig. 2. Optical coherence tomography angiography of the left eye on presentation, AngioVue Retina mode. Microaneurysms are defined as round “hollow” hyperreflective areas in the deep vascular plexus (yellow arrows) on the cross-section. Capillary density loss was recorded in the superficial vascular plexus in the parafoveal zone using the Vessel density mode. On retinal thickness map, an increase is observed in all quadrants, central retinal thickness is 702 µm

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4. Fig. 3. Fluorescein angiography of the left eye before treatment: a, arteriovenous phase, multiple parafoveal microaneurysms mainly in the temporal sector; b, venous phase, extravasal fluorescence in the locations of the majority of microaneurysms; c, late phase, increase in intensity of transsudation, diffuse hyperfluorescence in the parafoveal area

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5. Fig. 4. Fluorescein angiography: a, arteriovenous phase, multiple microaneurysms are detected (yellow circles). Optical coherence tomography: b, En Face mode (IPL–IPL +20 µm); c, En Face mode (IPL–IPL +60 µm); microaneurysms are defined as round hyperreflective areas (yellow circles) and topographically correspond to aneurysms on fluorescein angiography images

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6. Fig. 5. Navigated laser photocoagulation of microaneurysms: a, the combined image, fundus photography and fluorescein angiography images; b, single applicates are located on the areas of microaneurysms on the combined image; c, laser treatment protocol, laser coagulates are applied to the eye fundus in accordance with the predetermined plan

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7. Fig. 6. Optical coherence tomography-angiography of the macular zone of the left eye in dynamics: retinal thickness map (top), cross-section (bottom). Progressive decrease in the height of retinal edema and decrease in the number of intraretinal cystoid spaces were detected

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8. Fig. 7. Fluorescein angiography of the left eye in 2 months after treatment: a, venous phase, decrease in number and size of microaneurysms; b, late phase, reduced number of leakage points, decrease in intensity of dye transsudation

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