Intravitreal Ranibizumab and Laser Photocoagulation in the Management of Idiopathic Juxtafoveolar Retinal Telangiectasia Type 1: A Case Report

Abstract

Background: Idiopathic juxtafoveolar retinal telangiectasia (IJRT) type 1 represents an uncommon cause of congenital unilateral visual loss and it typically affects males. Decrease in visual acuity is caused by serous and lipid exudation into the fovea with cystoid macular edema. In some cases, spontaneous resolution may be observed, but when there is a progressive loss of visual acuity, laser photocoagulation is often necessary. This treatment is not always successful and therapy for this condition is still controversial. Case Presentation: A 57-year-old man referred a 2-month history of blurred and distorted vision in the right eye. Best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination showed temporal macular edema, confirmed by optical coherence tomography. Fluorescein angiography showed a localized area of hyperfluorescence probably due to telangiectasia type 1 located below the inferior temporal area of the fovea. A combined therapy of intravitreal ranibizumab injection and laser photocoagulation was performed. Visual acuity improved from 20/50 to 20/32 and the therapy was well tolerated by the patient. After 3 years of follow-up, both visual acuity and fundus examination were stable. Conclusions: This case suggests that the combined use of ranibizumab and laser photocoagulation may be considered an effective treatment for JRT type 1, leading to an improvement in both visual acuity and macular edema. We believe that intravitreal ranibizumab injection associated with laser photocoagulation should be considered as treatment for IJRT type 1.

Pars Plana Vitrectomy Combined with Focal Endolaser Photocoagulation for Idiopathic Macular Telangiectasia

“…Several treatments have been reported to be effective for MacTel, especially for type 2 [ 7 , 8 , 11 ], and there are few reports on the treatment of MacTel type 1 [ 4 , 8 – 10 ]. IVTA or STTA has been reported to be effective in some cases [ 3 – 7 ] because steroids are anti-inflammatory and might maintain the blood-retina barrier.…”

“…IVTA or STTA has been reported to be effective in some cases [ 3 – 7 ] because steroids are anti-inflammatory and might maintain the blood-retina barrier. Recently, antiangiogenic drugs such as bevacizumab or ranibizumab have been reported to be effective in some cases of MacTel type 1 [ 8 – 10 ]. Antiangiogenic drugs are known to reduce neovascularization and oedema; however the follow-up times in those reports were relatively short and some cases had recurrences.…”

“…The temporal half of the macula is involved by the telangiectasis, and the macular oedema and hard exudates lead to vision reduction. No treatment has been established although some encouraging effects have been obtained by argon laser photocoagulation (PC) [ 4 , 5 ], intravitreal or sub-Tenon's capsule injection of triamcinolone acetonide (IVTA or STTA) [ 5 – 7 ], or intravitreal bevacizumab (IVR) or ranibizumab (IVB) injections [ 8 – 10 ] in small case series.…”

Macular teleangiectasia – a diagnostic and therapeutic challenge

“…Teleangiektazje plamkowe -wyzwanie diagnostyczno-terapeutyczne tral Retinal Thickness). Są stosowane jako terapie łączone z fotokoagulacją laserową (7)(8)(9)(10)(11). Aktualnie dostępne metody terapeutyczne nie są skuteczne w leczeniu MacTel typu 2. w stadium nieproliferacyjnym.…”

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

“…Intravitreal anti–vascular endothelial growth factor (VEGF) therapy has also been assessed, with inconstant results. Although bevacizumab 6 , 7 and ranibizumab 8 , 9 showed some efficacy in reducing macular edema and improving vision, three case series reported that only a minority of patients responded favorably to intravitreal bevacizumab. 10 – 12 Recently, three groups reported that MacTel 1 patients may be nonresponders or become refractory to bevacizumab 13 – 15 or ranibizumab, 15 including two case reports describing a favorable response after switching to intravitreal aflibercept.…”