Efficacy of Intravitreal Aflibercept in Macular Telangiectasia Type 1 Is Linked to the Ocular Angiogenic Profile

Kowalczuk, Laura; Matet, Alexandre; Dirani, Ali; Daruich, Alejandra; Ambresin, Aude; Mantel, Irmela; Spaide, Richard F.; Turck, Natacha

doi:10.1097/iae.0000000000001424

Cited by 12 publications

(4 citation statements)

References 57 publications

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“…Previous reports used anti-VEGF drugs [8-10] with inconstant results probably because VEGF-A is not overexpressed in this disease. On the contrary, placental-growth factor was found to be increased in the humor aqueous of MacTel 1 patients and might be the reason for a better clinical response with intravitreal aflibercept [11].…”

Section: Discussionmentioning

confidence: 99%

Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1

Cirafici

Musolino

Saccheggiani

et al. 2021

Case Rep Ophthalmol

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This is a report of 3 patients diagnosed with idiopathic macular telangiectasia type 1 (MacTel 1) at Medical Retina Center of the University of Eye Clinic of Genova and then prospectically followed for a mean time of 26 months between 2016 and 2019. It is the first report of patients affected by MacTel 1 treated with dexamethasone (DEX) implant as a first choice of treatment. Aim of our study is to better characterize the disease using a multimodal wide-field imaging and to determine efficacy of DEX implant on MacTel 1 in terms of central macular thickness (CMT) and best-corrected visual acuity (BCVA). MacTel 1 is a rare unilateral disease, characterized by telangiectatic retinal capillaries, cystoid macular edema, and lipid deposition occurring temporal to the fovea. Patients underwent a comprehensive ophthalmic examination, BCVA, swept-source optical coherence tomography (SS-OCT), SS-OCT angiography (SS-OCTA), ultra-widefield (UWF) color, and fluorescein angiography (FA) fundus photograph. All the patients presented monolateral reduced BCVA and macular edema with increased CMT evaluated by SS-OCT. With SS-OCTA, we showed that the telangiectasia-associated vascular changes originate in the deep retinal vascular plexus and as a consequence macular edema and exudation develop causing vision loss. Furthermore, UWF imaging helped us to highlight vascular changes typical of Coats Disease at the far retinal periphery. All the patients were treated with DEX intravitreal implant, showing a decrease in CMT and a stabilization of visual acuity. Due to the recurrent nature of macular edema, patients underwent a mean of 4 DEX implants during the follow-up period. In order to address the clinical features of this uncommon disease avoiding diagnostic errors, it might be important to use a multimodal imaging approach. The anatomical and functional beneficial effects of DEX implant were well evident although transient.

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Section: Discussionmentioning

confidence: 99%

Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1

Cirafici

Musolino

Saccheggiani

et al. 2021

Case Rep Ophthalmol

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“…The authors suggested that the eyes’ clinical response to aflibercept coupled to the angiogenic profile of MacTel 1 eyes supported the implication of the placental growth factor/Flt-1 pathway in MacTel 1. As MacTel 1 appears to share a similar pathogenetic development with Lebers’ milliary aneurysm and Coats’ syndrome as telangeictatic and aneurysmal retinal diseases, the authors postulate that the better efficacy of aflibercept compared to other anti-VEGF injections may be due to its anti-placental growth factor activity [ 8 ]. Comparing effects between different anti-VEGF modalities in such a rare disease such as adult-onset Coat's disease requires studies on a larger scale, which we know is not possible in such rare cases.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Results of Management of Adult-Onset Coats' Disease by Possibly Targeting Placental Growth Factor

Alsaggaf

Jalloun

Alkhotani

et al. 2020

Cureus

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We report long-term results of treatment with intravitreal injection of aflibercept in a newly diagnosed case of adult-onset Coats' disease. A 40-year-old Philipino male was referred to our Eye Center complaining of vision reduction for the past three months in his right eye. Examination revealed visual acuity of 0.1 in the affected right eye with normal vision of 1.0 in his left eye. Fundal examination of the right eye showed temporal retinal telangiectasia with massive exudation reaching the macula. The left fundal examination was normal. The patient’s optical coherence tomography (OCT) demonstrated massive exudative thickening. The patient was managed with one intravitreal injection of aflibercept followed by focal laser, with successful anatomical and subjective outcomes that were maintained after three years. Aflibercept's profile targeting both vascular endothelial growth factor (VEGF) and placental growth factor seems to show favorable outcomes when compared to other purely anti-VEGF treatment options. We therefore believe that aflibercept is an excellent adjunctive therapy in cases of adult-onset Coats’ disease with macular edema. To our knowledge, this is the first case treated with laser and intravitreal aflibercept with a long three-year follow-up suggesting the significant role of aflibercept in vascular permeability and supporting its use as a valuable therapeutic option for Coats’ disease.

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“…Our patient was treated with 2 injections of intravitreal bevacizumab and 1 of IVTA, without therapeutic effect. Therefore, aflibercept, which blocks both VEGF-A and placental growth factor, may be more effective in type 1 IMT than other anti-VEGFs and could be another treatment option in drug-resistant cases [5]. Laser photocoagulation remains most effective in type 1 IMT, but conventional photocoagulation produces thermal damage to photoreceptors of the inner retina, which is unacceptable near the fovea [2].…”

Section: Subthreshold Micropulse Yellow Laser (577 Nm) For Idiopathicmentioning

confidence: 99%

Subthreshold Micropulse Yellow Laser (577 nm) for Idiopathic Macular Telangiectasia Type 1 Resistant to Intravitreal Injection

Kang

Park

2020

Korean J Ophthalmol

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Efficacy of Intravitreal Aflibercept in Macular Telangiectasia Type 1 Is Linked to the Ocular Angiogenic Profile

Cited by 12 publications

References 57 publications

Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1

Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1

Three-Year Results of Management of Adult-Onset Coats' Disease by Possibly Targeting Placental Growth Factor

Subthreshold Micropulse Yellow Laser (577 nm) for Idiopathic Macular Telangiectasia Type 1 Resistant to Intravitreal Injection

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