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

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Abstract

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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About the authors

Pavel L. Volodin

S. Fyodorov Eye Microsurgery Federal State Institution

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

MD, Dr. Sci. (Medicine)

Russian Federation, 59a Beskudnikovsii blvd, Moscow, 127486

Elena V. Ivanova

S. Fyodorov Eye Microsurgery Federal State Institution

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

MD, Cand. Sci. (Medicine)

Russian Federation, 59a Beskudnikovsii blvd, Moscow, 127486

Sofia I. Belianina

S. Fyodorov Eye Microsurgery Federal State Institution

Author for correspondence.
Email: sofiabelyanina00@mail.ru
ORCID iD: 0000-0002-5982-9396
SPIN-code: 6312-7830

MD

Russian Federation, 59a Beskudnikovsii blvd, Moscow, 127486

References

  1. Graefe CF. Angiectasie, ein Beitrag zur rationellen Cur und Erkenntniss der Gefäßausdehnungen. Leipzig: Kohler; 1808. (In German)
  2. Gass JDM. A fluorescein angiographic study of macular dysfunction secondary to retinal vascular disease. V. Retinal telangiectasis. Arch Ophthalmol. 1968;80(5):592–605. doi: 10.1001/archopht.1968.00980050594005
  3. Gass JD, Oyakawa RT. Idiopathic juxtafoveolar retinal telangiectasis. Arch Ophthalmol. 1982;100(5):769–780. doi: 10.1001/archopht.1982.01030030773010
  4. Gass JD, Blodi BA. Idiopathic juxtafoveolar retinal telangiectasis. Update of classification and follow-up study. Ophthalmology. 1993;100(10):1536–1546. doi: 10.1016/s0161-6420(93)31447-8
  5. Yannuzzi LA, Bardal AMC, Freund KB, et al. Idiopathic macular telangiectasia. Arch Ophthalmol. 2006;124(4):450–460. doi: 10.1001/archopht.124.4.450
  6. Ageeva OV, Gatsu M.V. Macular telangiectasia type 2. Fyodorov Journal of Ophthalmic Surgery. 2023;(3S):102–108. EDN: PYNORR doi: 10.25276/0235-4160-2023-3S-102-108
  7. Lee SW, Kim SM, Kim YT, Kang SW. Clinical features of idiopathic juxtafoveal telangiectasis in Koreans. Korean J Ophthalmol. 2011;25(4):225–230. doi: 10.3341/kjo.2011.25.4.225
  8. Maruko I, Iida T, Sugano Y, et al. Demographic features of idiopathic macular telangiectasia in Japanese patients. Jpn J Ophthalmol. 2012;56(2):152–158. EDN: IUNNMR doi: 10.1007/s10384-011-0112-5
  9. Lee KE, Jeng-Miller KW, Yonekawa Y. Macular telangiectasia type 1. Ophthalmol Retina. 2017;1(5):381. doi: 10.1016/j.oret.2017.01.006
  10. Cirafici P, Musolino M, Saccheggiani M, et al. Multimodal imaging findings and treatment with dexamethasone implant in three cases of idiopathic macular telangiectasia type 1. Case Rep Ophthalmol. 2021;12(1):92–97. EDN: NBPOWY doi: 10.1159/000509850
  11. Fadeeva A.V., Turutina A.O., Morozova Yu.V., et al. To the question of micropulse laser action on idiopathic telangiectasias. In: Russian national ophthalmologic forum, 12th: Collection of scientific works: In 2 vol. Vol. 1. Edited by V.V. Neroev. Moscow: April, 2019. С. 118–120. (In Russ.) EDN: FDLZZT
  12. Nakai M, Iwami H, Fukuyama H, Gomi F. Visualization of microaneurysms in macular telangiectasia type 1 on optical coherence tomography angiography before and after photocoagulation. Graefes Arch Clin Exp Ophthalmol. 2021;259(6):1513–1520. EDN: RIBRNT doi: 10.1007/s00417-020-04953-9
  13. Chatziralli IP, Sharma PK, Sivaprasad S. Treatment modalities for idiopathic macular telangiectasia: an evidence-based systematic review of the literature. Semin Ophthalmol. 2017;32(3):384–394. doi: 10.3109/08820538.2015.1096399
  14. Takayama K, Ooto S, Tamura H, et al. Intravitreal bevacizumab for type 1 idiopathic macular telangiectasia. Eye. 2010;24:1492–1497. doi: 10.1038/eye.2010.61.
  15. Kozak I, Oster SF, Cortes MA, et al. Clinical evaluation and treatment accuracy in diabetic macular edema using navigated laser photocoagulator NAVILAS. Ophthalmology. 2011;118(6):1119–1124. doi: 10.1016/j.ophtha.2010.10.007
  16. Kernt M, Cheuteu R, Liegl RG, et al. Navigierte fokale retinale Lasertherapie mit dem NAVILAS®-System bei diabetischem Makulaödem. Ophthalmologe. 2012;109(7):692–698. EDN: YUPXSL doi: 10.1007/s00347-012-2559-2 (In German)
  17. Boiko EV, Maltsev DS. Confocal scanning laser ophthalmoscopy planning for navigated macular laser photocoagulation. Russian Ophthalmological Journal. 2016;9(3):12–17. EDN: WKRGEF doi: 10.21516/2072-0076-2016-9-3-12-17
  18. Volodin PL, Doga AV, Ivanova EV, et al. The personalized approach to the chronic central serous chorioretinopathy treatment based on the navigated micropulse laser technology. Ophthalmology in Russia. 2018;15(4):394–404. EDN: VPUTTA doi: 10.18008/1816-5095-2018-4-394-404
  19. Volodin PL, Ivanova EV. Clinical evaluation of individualized and navigated microsecond pulsing laser for acute central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina. 2020;51(9): 512–520. EDN: WILJTP doi: 10.3928/23258160-20200831-06
  20. Volodin PL, Ivanova EV, Polyakova EYu, et al. Application of micro-pulse and continuous laser radiation in navigation topographically-oriented treatment of focal diabetic macular edema based. Ophthalmology in Russia. 2022;19(3):506–514. EDN: SKKJSX doi: 10.18008/1816-5095-2022-3-506-514
  21. Chen Y-G, Chang Y-H. Multimodal imaging in the diagnosis of macular telangiectasia type 1. Asia Pac J Ophthalmol (Phila). 2022;11(4):397. EDN: VAPSDG doi: 10.1097/APO.0000000000000476
  22. Gamulescu MA, Walter A, Sachs H, Helbig H. Bevacizumab in the treatment of idiopathic macular telangiectasia. Graefes Arch Clin Exp Ophthalmol. 2008;246(8):1189–1193. EDN: HMCYNW doi: 10.1007/s00417-008-0795-6
  23. Kotoula MG, Chatzoulis DZ, Karabatsas CH, et al. Resolution of macular edema in idiopathic juxtafoveal telangiectasis using PDT. Ophthalmic Surg Lasers Imaging. 2009;40(1):65–67. doi: 10.3928/15428877-20090101-10

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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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