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Govindaraj I, Mahalingam M, Maheswari U, Kumar HSY, Suganya BS, Subramanian V, Rajendran A. Quantification of vascular changes in macular telangiectasia type 2 with AngioTool software. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06487-w. [PMID: 38676751 DOI: 10.1007/s00417-024-06487-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE To compare AngioTool (AT) vascular parameters (VP) between MacTel2 eyes and normal eyes. Secondary outcome measures were to correlate VP with BCVA and to analyze VP between various grades of Simple MacTel Classification. METHODS This is a retrospective study. SD OCTA images of the superficial vascular complex (SVC) and deep capillary complex (DVC) were exported into Image J and AT. The explant area (EA), vessel area (VA), vessel percentage area (VPA), total number of junctions (TNJ), junction density (JD), total vessel length (TVL), average vessel length (AVL), total number of endpoints (TNE) and mean E lacunarity (MEL) were studied. RESULTS Group 1 had 120 MacTel2 eyes. Group 2 had 60 age-matched normal eyes. All VP were significantly different between the two groups except EA and TNE in both complexes. None of the VP had a correlation with BCVA. Interquadrant analysis (IQA) in SVC and DVC showed statistical significance in VPA, AVL and JD and in AVL, TNE, JD, VPA respectively. Post hoc analysis in SVC and DVC showed statistical significance in TNJ, JD, TVL and AVL between grade 1 and grade 3, and in VA, VPA, TNJ, JD, TVL and MEL between grade 0 and grade 3 respectively. CONCLUSION VP were affected in MacTel2 eyes. VP did not correlate with BCVA. Occurrence of pigmentation is an important event in the progression of disease. AT may provide quantitative markers to measure disease progression.
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Affiliation(s)
- Indu Govindaraj
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Maanasi Mahalingam
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Uma Maheswari
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - H S Yeshwanth Kumar
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - B S Suganya
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Vishnu Subramanian
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India.
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Manayath GJ, Verghese S, Narendran V. MULTIMODAL IMAGING OF UNILATERAL IDIOPATHIC MACULAR TELANGIECTASIA TYPE 2: A FIVE-YEAR STUDY. Retin Cases Brief Rep 2024; 18:230-235. [PMID: 36026689 DOI: 10.1097/icb.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To report a rare presentation of unilateral macular telangiectasia Type 2 followed up over 5 years. METHODS Case report. RESULTS A 58-year-old man presented to us with complaints of painless progressive reduction of vision in the right eye for the past 2 years. He had no systemic illnesses. On examination, his best corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Fundus examination in the right eye revealed loss of foveal reflex along with mild temporal graying of the fovea, and the left eye revealed results within the normal limits. Both eyes showed the presence of peripapillary myelinated nerve fibers. Multimodal imaging findings included spectral-domain optical coherence tomography, optical coherence tomography angiography, fundus autofluorescence, and fundus fluorescein angiogram, which revealed findings suggestive of exudative preproliferative variant of Mac-Tel 2 in the right eye, whereas the left eye was showed results within normal limits. After a follow-up of 5 years, spectral-domain optical coherence tomography and optical coherence tomography angiography revealed no striking differences in both eyes, with no evidence of the disease in his left eye. CONCLUSION This report highlights a rare advanced unilateral presentation of Mac-Tel 2 with no evidence of even early signs of the disease in the fellow eye, over a long-term follow-up.
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Affiliation(s)
- George J Manayath
- Department of Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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Goździewska E, Wichrowska M, Kocięcki J. Early Optical Coherence Tomography Biomarkers for Selected Retinal Diseases-A Review. Diagnostics (Basel) 2023; 13:2444. [PMID: 37510188 PMCID: PMC10378475 DOI: 10.3390/diagnostics13142444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive, easily accessible imaging technique that enables diagnosing several retinal diseases at various stages of development. This review discusses early OCT findings as non-invasive imaging biomarkers for predicting the future development of selected retinal diseases, with emphasis on age-related macular degeneration, macular telangiectasia, and drug-induced maculopathies. Practitioners, by being able to predict the development of many conditions and start treatment at the earliest stage, may thus achieve better treatment outcomes.
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Affiliation(s)
- Ewa Goździewska
- Department of Ophthalmology, Poznan University of Medical Sciences, 60-569 Poznań, Poland
| | - Małgorzata Wichrowska
- Department of Ophthalmology, Poznan University of Medical Sciences, 60-569 Poznań, Poland
- Doctoral School, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jarosław Kocięcki
- Department of Ophthalmology, Poznan University of Medical Sciences, 60-569 Poznań, Poland
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OUTER FOVEAL DEFECTS IN TYPE-2 MACULAR TELANGIECTASIA. Retina 2023; 43:111-119. [PMID: 36542082 DOI: 10.1097/iae.0000000000003640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To report characteristics of outer foveal defects (OFDs) in type-2 macular telangiectasia (MacTel) on spectral domain optical coherence tomography. METHODS This was a single-center observational study. From a registry of 745 patients with MacTel, patients with OFDs were characterized. All patients underwent multimodal imaging including color fundus photography, confocal blue reflectance, fundus autofluorescence, and spectral domain optical coherence tomography. Staging of eyes was done using the Gass and Blodi classification. Spectral domain optical coherence tomography characteristics in the central 1 mm of the macula in eyes with OFD are reported. RESULTS Outer foveal defect was observed in 21 eyes of 15/745 (2%) patients with MacTel. These defects were bilateral in 6/15 (40%) patients and seen in stage 2 MacTel eyes. In order of prevalence, foveal parameters seen in OFD included hyper-reflective dots in outer retina in 19/21 (90%), ellipsoid zone loss in 18/21 (86%) eyes, interdigitation zone loss in 17/21 (81%) eyes, outer retinal hyporeflective cavitation in 14 (67%) eyes, hyporeflective cavitation at foveal pit in 8 (38%) eyes, and loss of external limiting membrane in 1 (5%) eye. The mean baseline length of the foveal ellipsoid zone loss was 240.17 ± 117.249 µm. The mean baseline central subfield thickness was 155.43 ± 17.215 µm. A total of 8/11 eyes (73%) showed an increase in size of OFD on follow-up. CONCLUSION Outer foveal defect in MacTel eyes is characterized predominantly by foveal loss of ellipsoid zone and interdigitation zone with relative preservation of external limiting membrane.
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Venkatesh R, Reddy NG, Mishra P, Agrawal S, Mutalik D, Yadav NK, Chhablani J. Spectral domain OCT features in type 2 macular telangiectasia (type 2 MacTel): its relevance with clinical staging and visual acuity. Int J Retina Vitreous 2022; 8:26. [PMID: 35382904 PMCID: PMC8981685 DOI: 10.1186/s40942-022-00378-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To report spectral domain optical coherence tomography (SDOCT) imaging findings in type 2 macular telangiectasia (MacTel) and correlate them with clinical stages and visual acuity.
Methods
This retrospective, cross-sectional study included type 2 MacTel cases who underwent SDOCT imaging with Spectralis machine. Macular SDOCT images were analysed. Imaging features were tested for correlation with different clinicals stages and visual acuity.
Results
212 eyes of 108 type 2 MacTel patients were included. Hyperreflective middle retinal layer (87%) was the most frequently detected abnormality. This was followed by inner retinal cavities (49%), outward bending of inner retinal layers (35%), retinal pigment clumps (35%) and foveal contour irregularity (31%). Hyperreflective middle retinal layers (p < 0.001), inner (p = 0.032) and outer retinal (p = 0.002) cavities and internal limiting membrane drape (p = 0.031) were associated with poor vision in non-proliferative group and presence of retinal pigment clumps (p = 0.002), subretinal fluid (p = 0.037) and foveal contour irregularity (p < 0.001) were associated with poor vision in proliferative group.
Conclusion
The described SDOCT features are practical for the diagnosis and staging in type 2 MacTel. Presence of hyperreflective middle retinal layers, hyporeflective inner and outer retinal cavities and internal limiting membrane drape were associated with poor vision in the non-proliferative group while retinal pigment clumps and subretinal neovascular membrane were associated with proliferative group and poor vision. Further long-term studies are required to describe the progressive and sequential changes on SDOCT.
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Venkatesh R, Reddy NG, Mishra P, Pereira A, Mutalik D, Agrawal S, Bhatt A, Yadav NK, Chhablani J. The preproliferative stage in type 2 macular telangiectasia (MacTel type 2). Graefes Arch Clin Exp Ophthalmol 2021; 260:121-132. [PMID: 34410484 DOI: 10.1007/s00417-021-05371-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To study clinical and imaging features of various stages of macular telangiectasia (MacTel type 2). METHODS In this retrospective study, cases of MacTel type 2 with fluorescein angiography (FA), optical coherence tomography (OCT) and OCT-angiography (OCTA) imaging were included. Based on angiographic perifoveal fluorescence, two groups were formed: group 1: diffuse hyperfluoroscence and group 2: diffuse + focal hyperfluoroscence. Later, based on OCT features, group 2 was subdivided into group 2A: without SRNVM and group 2B: with SRNVM. Clinical, FA, OCT and OCTA features were analysed. Eyes showing conversion to the proliferative stage at final visit were noted. RESULTS Ninety-four eyes of 48 patients were included. Group 1 (n = 28) showed diffuse perifoveal hyperfluoroscence, hyperreflective middle retinal layers, absent SRNVM (p = 0.006) on OCT and dilated perifoveal capillaries in deep capillary plexus (DCP) on OCTA. Group 2A (n = 40) showed diffuse + focal perifoveal hyperfluoroscence, hyperreflective middle retinal layers (p = 0.001), hyporeflective outer retina cavities (p = 0.021), absent SRNVM with dilated and bunching perifoveal capillaries (p = 0.004) in DCP. Group 2B (n = 26) showed late diffuse + focal perifoveal hyperfluoroscence, foveal contour irregularity (p = 0.002), retinal pigment clumps (p = 0.015) and SRNVM on OCT with bunching of capillaries in DCP and vessels in outer retina (p = 0.002). Five eyes showed conversion to group 2B at final visit. CONCLUSION There exists a distinct disease stage called "preproliferative" MacTel type 2 showing clinical features of non-proliferative disease, diffuse + focal perifoveal hyperfluoroscence on FA, absent SRNVM on OCT and bunching perifoveal capillaries in DCP on OCTA. Its identification is important for suspecting proliferative disease, planning management and follow-up visit accordingly.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Pranjal Mishra
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Arpitha Pereira
- Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, LL22 8DP, UK
| | - Deepashri Mutalik
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Sameeksha Agrawal
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Abhishek Bhatt
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Microvascular changes precede visible neurodegeneration in fellow eyes of patients with asymmetric type 2 macular telangiectasia. Eye (Lond) 2021; 36:1623-1630. [PMID: 34326496 PMCID: PMC9307587 DOI: 10.1038/s41433-021-01699-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022] Open
Abstract
IMPORTANCE Macular telangiectasia type 2 (MacTel) is bilateral disease with characteristic alterations of the macular capillary network along with decreased macular pigment in the parafoveal area. The purpose of this study was to highlight that some eyes show microvascular changes which precede any visible neuronal changes on spectral-domain optical coherence tomography (SD-OCT). METHODS This observational study was conducted at a tertiary eye institute. From a registry of 630 patients with MacTel, we identified 4 patients with typical MacTel characteristics in only one eye with no visible changes on colour photographs or SD-OCT in the fellow eye. These 4 patients had findings of MacTel documented by colour fundus photograph, multicolour imaging (MCI), fundus autofluorescence (FAF), confocal blue reflectance (CBR), SD-OCT, and OCT-Angiography (OCT-A) in one eye. OCT-A was performed in MacTel patients using the High-resolution Spectralis (Heidelberg Engineering) module with a full-spectrum probabilistic approach and we employed a 30° x 15° (~8.8 mm × 4.4 mm) scan pattern covering the macula. MCI was done at the end so as to avoid fading the confocal blue reflectance hyperreflectivity seen in MacTel. RESULTS On OCT-A, all 4 fellow eyes showed telangiectasia and foveal avascular zone changes in the superficial and deep capillary plexuses with no changes on SD-OCT. None of the eyes showed typically increased reflectance on CBR around the foveal area. CONCLUSION These findings show that microvascular changes on OCT-A may occur before visible neurodegenerative changes on OCT, providing new insights into the course of the disease.
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