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

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.

Keywords

macular telangiectasia type 1 / MacTel1 / optical coherence tomography-angiography / fluorescein angiography / navigated laser therapy / laser coagulation / antiangiogenic therapy

References

[1] Graefe CF. Angiectasie, ein Beitrag zur rationellen Cur und Erkenntniss der Gefäßausdehnungen. Leipzig: Kohler; 1808. (In German)

[2] Graefe C.F. Angiectasie, ein Beitrag zur rationellen Cur und Erkenntniss der Gefäßausdehnungen. Leipzig: Kohler, 1808.

[3] 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

[4] Gass J.D.M. A fluorescein angiographic study of macular dysfunction secondary to retinal vascular disease. V. Retinal telangiectasis // Arch Ophthalmol. 1968. Vol. 80, N 5. P. 592–605. doi: 10.1001/archopht.1968.00980050594005

[5] Gass JD, Oyakawa RT. Idiopathic juxtafoveolar retinal telangiectasis. Arch Ophthalmol. 1982;100(5):769–780. doi: 10.1001/archopht.1982.01030030773010

[6] Gass J.D., Oyakawa R.T. Idiopathic juxtafoveolar retinal telangiectasis // Arch Ophthalmol. 1982. Vol. 100, N 5. P. 769–780. doi: 10.1001/archopht.1982.01030030773010

[7] 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

[8] Gass J.D., Blodi B.A. Idiopathic juxtafoveolar retinal telangiectasis. Update of classification and follow-up study // Ophthalmology. 1993. Vol. 100, N 10. P. 1536–1546. doi: 10.1016/s0161-6420(93)31447-8

[9] 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

[10] Yannuzzi L.A., Bardal A.M.C., Freund K.B., et al. Idiopathic macular telangiectasia // Arch Ophthalmol. 2006. Vol. 124, N 4. P. 450–460. doi: 10.1001/archopht.124.4.450

[11] 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

[12] Агеева О.В., Гацу М.В. Макулярные телеангиэктазии 2-го типа // Офтальмохирургия. 2023. № 3S. С. 102–108. EDN: PYNORR doi: 10.25276/0235-4160-2023-3S-102-108

[13] 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

[14] Lee S.W., Kim S.M., Kim Y.T., Kang S.W. Clinical features of idiopathic juxtafoveal telangiectasis in Koreans // Korean J Ophthalmol. 2011. Vol. 25, N 4. P. 225–230. doi: 10.3341/kjo.2011.25.4.225

[15] 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

[16] Maruko I., Iida T., Sugano Y., et al. Demographic features of idiopathic macular telangiectasia in Japanese patients // Jpn J Ophthalmol. 2012. Vol. 56, N 2. P. 152–158. EDN: IUNNMR doi: 10.1007/s10384-011-0112-5

[17] 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

[18] Lee K.E., Jeng-Miller K.W., Yonekawa Y. Macular telangiectasia type 1 // Ophthalmol Retina. 2017. Vol. 1, N 5. P. 381. doi: 10.1016/j.oret.2017.01.006

[19] 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

[20] 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. Vol. 12, N 1. P. 92–97. EDN: NBPOWY doi: 10.1159/000509850

[21] 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

[22] Фадеева А.В., Турутина А.О., Морозова Ю.В., и др. К вопросу о микроимпульсном лазерном воздействии на идиопатические телеангиоэктазии. В кн.: Российский общенациональный офтальмологический форум, 12-й: Сб. науч. тр.: В 2 т. Т. 1. / под ред. В.В. Нероева. Москва: Апрель, 2019. С. 118–120. EDN: FDLZZT

[23] 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

[24] 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. Vol. 259, N 6. P. 1513–1520. EDN: RIBRNT doi: 10.1007/s00417-020-04953-9

[25] 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

[26] Chatziralli I.P., Sharma P.K., Sivaprasad S. Treatment modalities for idiopathic macular telangiectasia: an evidence-based systematic review of the literature // Semin Ophthalmol. 2017. Vol. 32, N 3. P. 384–394. doi: 10.3109/08820538.2015.1096399

[27] 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.

[28] Takayama K., Ooto S., Tamura H., et al. Intravitreal bevacizumab for type 1 idiopathic macular telangiectasia // Eye. 2010. Vol. 24. P. 1492–1497. doi: 10.1038/eye.2010.61.

[29] 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

[30] Kozak I., Oster S.F., Cortes M.A., et al. Clinical evaluation and treatment accuracy in diabetic macular edema using navigated laser photocoagulator NAVILAS // Ophthalmology. 2011. Vol. 118, N 6. P. 1119–1124. doi: 10.1016/j.ophtha.2010.10.007

[31] 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)

[32] Kernt M., Cheuteu R., Liegl R.G., et al. Navigierte fokale retinale Lasertherapie mit dem NAVILAS®-System bei diabetischem Makulaödem // Ophthalmologe. 2012. Vol. 109, N 7. P. 692–698. EDN: YUPXSL doi: 10.1007/s00347-012-2559-2

[33] 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

[34] Бойко Э.В., Мальцев Д.С. Планирование навигационной макулярной лазерной коагуляции на основании конфокальной сканирующей лазерной офтальмоскопии // Российский офтальмологический журнал. 2016. Т. 9, № 3. С. 12–17. EDN: WKRGEF doi: 10.21516/2072-0076-2016-9-3-12-17

[35] 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

[36] Володин П.Л., Дога А.В., Иванова Е.В., и др. Персонализированный подход к лечению хронической центральной серозной хориоретинопатии на основе навигационной технологии микроимпульсного лазерного воздействия // Офтальмология. 2018. Т. 15, № 4. С. 394–404. EDN: VPUTTA doi: 10.18008/1816-5095-2018-4-394-404

[37] 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

[38] Volodin P.L., Ivanova E.V. Clinical evaluation of individualized and navigated microsecond pulsing laser for acute central serous chorioretinopathy // Ophthalmic Surg Lasers Imaging Retina. 2020. Vol. 51, N 9. P. 512–520. EDN: WILJTP doi: 10.3928/23258160-20200831-06

[39] 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

[40] Володин П.Л., Иванова Е.В., Полякова Е.Ю., и др. Применение микроимпульсного и непрерывного лазерного излучения при навигационном топографически ориентированном лечении фокального диабетического макулярного отёка // Офтальмология. 2022. Т. 19, № 3. С. 506–514. EDN: SKKJSX doi: 10.18008/1816-5095-2022-3-506-514

[41] 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

[42] Chen Y.-G., Chang Y.-H. Multimodal imaging in the diagnosis of macular telangiectasia type 1 // Asia Pac J Ophthalmol (Phila). 2022. Vol. 11, N 4. P. 397. EDN: VAPSDG doi: 10.1097/APO.0000000000000476

[43] 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

[44] Gamulescu M.A., Walter A., Sachs H., Helbig H. Bevacizumab in the treatment of idiopathic macular telangiectasia // Graefes Arch Clin Exp Ophthalmol. 2008. Vol. 246, N 8. P. 1189–1193. EDN: HMCYNW doi: 10.1007/s00417-008-0795-6

[45] 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

[46] Kotoula M.G., Chatzoulis D.Z., Karabatsas C.H., et al. Resolution of macular edema in idiopathic juxtafoveal telangiectasis using PDT // Ophthalmic Surg Lasers Imaging. 2009. Vol. 40, N 1. P. 65–67. doi: 10.3928/15428877-20090101-10

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