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.

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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

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Differential diagnosis:

1. Inflammatory / vaso-occlusive diseases

2. BRVO

3. DR

4. AMD

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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.