Macular Telangiectasia

Definition: Abnormal dilatation of retinal capillaries.


Classification:

Type 1 (MacTel 1) – congenital unilateral – uncommon

Type 2 (MacTel 2) – acquired bilateral in middle aged – common

Type 3 – uncommon occlusive and rarely understood


Signs and symptoms:

  1. Asymptomatic +/- gradual reduction in vision.

  2. Foveal atrophy with CNV in severe cases.

  3. Can present with LMH or FTMH.

  4. Slit lamp – telangiectatic retinal capillaries with aneurysmal dilatations involving up to 2 DD temporal to fovea.

Investigations:

  1. FAF – hyperautofluorescent spot on fovea (due to Muller cells degeneration)

  2. FFA – CNV

  3. OCTA – Abnormal capillaries temporal fovea with atrophy

  4. OCT – cavitation lesions

Differential diagnosis:

  1. Inflammatory / vaso-occlusive diseases

  2. BRVO

  3. DR

  4. AMD

Management:

  1. Most do not treatment

  2. Ix for systemic conditions – DR, HTN.

  3. CNV – no effective Rx – can consider macular laser, anti-VEGF.

  4. FTMH – PPV + ILM peel + gas – poorer success rate.

 
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