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Huemer J, Heeren TF, Olvera-Barrios A, Faes L, Casella AMB, Hughes E, Tufail A, Egan C. Sight threatening diabetic retinopathy in patients with macular telangiectasia type 2. Int J Retina Vitreous 2024; 10:28. [PMID: 38475930 PMCID: PMC10936077 DOI: 10.1186/s40942-024-00545-5] [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: 01/14/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Although diabetes is highly prevalent in patients with MacTel, progression to severe non-proliferative (NPDR) and proliferative diabetic retinopathy (PDR) is rarely reported. We report multimodal imaging features of sight-threatening diabetic retinopathy (STDR) in eyes with macular telangiectasia type 2 (MacTel). METHODS Retrospective case series of seven participants of the MacTel Study at the Moorfields Eye Hospital NHS Foundation Trust study site and one patient from the Institute of Retina and Vitreous of Londrina, Brazil. Sight threatening diabetic retinopathy was defined as severe NPDR, PDR or diabetic macular edema. RESULTS We report imaging features of 16 eyes of eight patients (7/8, 87.5% female) with diagnoses of MacTel and type 2 diabetes mellitus with STDR. Mean (SD) age was 56 (8.3) years. Patients were followed-up for a mean time of 9.1 (4.7) years. A total of 10/16 (62.5%) eyes showed PDR and 2/16 (12.5%) eyes presented a macular epiretinal neovascularization. CONCLUSIONS People with diabetes mellitus and MacTel may not be protected from STDR as previously reported. Although the two diseases rarely co-exist, regular monitoring for diabetic retinopathy progression is recommended according to baseline retinopathy severity grades in line with established international guidelines. The presence of MacTel may not modify extended screening intervals, but there is no current evidence. The limited case series in the literature support treatment for complications and should follow the standard of care for either condition. Due to dual pathology, reactivation may be difficult to diagnose on standard imaging and multimodal imaging is recommended.
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Affiliation(s)
- Josef Huemer
- Moorfields Eye Hospital, NHS Foundation Trust, 62 City Rd., EC1V 2PD, London, UK
- Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
| | - Tjebo Fc Heeren
- Moorfields Eye Hospital, NHS Foundation Trust, 62 City Rd., EC1V 2PD, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Abraham Olvera-Barrios
- Moorfields Eye Hospital, NHS Foundation Trust, 62 City Rd., EC1V 2PD, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Livia Faes
- Moorfields Eye Hospital, NHS Foundation Trust, 62 City Rd., EC1V 2PD, London, UK
| | - Antonio M B Casella
- Department of Surgery, Health Sciences Center, Londrina State University, Paraná, Brazil
| | - Edward Hughes
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Adnan Tufail
- Moorfields Eye Hospital, NHS Foundation Trust, 62 City Rd., EC1V 2PD, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Catherine Egan
- Moorfields Eye Hospital, NHS Foundation Trust, 62 City Rd., EC1V 2PD, London, UK.
- University College London Institute of Ophthalmology, London, UK.
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Venkatesh R, Mangla R, Handa A, Parmar Y, Sangoram R, Chhablani J. Epiretinal membrane formation and optic disc vascularisation in type 2A macular telangiectasia (MacTel). Eur J Ophthalmol 2024; 34:NP78-NP82. [PMID: 37644815 DOI: 10.1177/11206721231198888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To describe a rare clinical finding of epiretinal membrane (ERM) and abnormal optic disc vascularisation in type 2A macular telangiectasia (MacTel). CASE DESCRIPTION A 52-year-old asymptomatic healthy male was examined in the retina clinic. In both eyes, corrected visual acuity was 20/20, N6. Anterior segment examination and intraocular pressure were both normal in both eyes. RESULTS The right eye's dilated fundus examination revealed loss of retinal transparency and superficial intraretinal crystals. A thick ERM extending from the optic disc to the macula obscured the details of the underlying perifoveal region in the left eye fundus. The diagnosis of bilateral type 2 MacTel was confirmed by confocal blue reflectance imaging, fluorescein angiography (FA), and macular optical coherence tomography (OCT). The left eye macular OCT scan also revealed a thick ERM without causing significant retinal traction. Furthermore, FA of the left eye revealed early hyperfluorescence with intense late leakage at the inferior aspect of the optic disc, giving the impression of abnormal optic disc vascularisation. No other cause for the disc vascularisation could be identified. OCT scan through the area with the optic disc leakage revealed a tuft of irregular hyperreflective tissue lying over the ERM. OCT angiography imaging confirmed the vascularity within the tuft of hyperreflective tissue over the ERM. Over a two-year period, no changes in clinical or imaging features were observed. CONCLUSION In type 2A MacTel eyes, ERM formation and abnormal disc vascularisation are uncommon findings. More histopathologic research is needed to characterise these membranes.
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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
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Yash Parmar
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Rohini Sangoram
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Jay Chhablani
- Department of Retina and Vitreous, University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburg 15213, PA, USA
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Sauer L, Vitale AS, Jacoby RS, Hart B, Bernstein PS. FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY IN PATIENTS WITH MACULAR TELANGIECTASIA TYPE 2 WITH AND WITHOUT DIABETES. Retina 2023; 43:1597-1607. [PMID: 37263186 PMCID: PMC10524946 DOI: 10.1097/iae.0000000000003851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Macular telangiectasia type 2 (MacTel) is a vision-altering retinal disease with a high prevalence of diabetes. Differences between patients with MacTel with and without diabetes were investigated using fluorescence lifetime imaging ophthalmoscopy (FLIO). METHODS Eighty-six patients with MacTel (59 ± 12 years) were included. 40 patients (46%) did not have diabetes, 16 patients (19%) were prediabetic, and 30 patients (35%) were diabetic. Of these, seven had diabetic retinopathy. 18 diabetic patients without MacTel and 42 age-matched healthy controls were included. FLIO lifetimes (FLTs) were obtained in short (SSC, 498-560 nm) and long (LSC, 560-720 nm) spectral channels from different areas of interest using a Heidelberg Engineering FLIO. RESULTS Fundus autofluorescece lifetimes did not show significant differences when comparing diabetic with nondiabetic MacTel eyes (MacTel zone, SSC, diabetic: 243 ± 65 ps; nondiabetic: 232 ± 51 ps; P = 1.0; LSC, diabetic: 327 ± 66 ps; nondiabetic: 309 ± 54 ps; P = 0.582). Longitudinal changes were similarly unrelated to diabetes status. A nonsignificant trend of increased FLT progression with higher body mass index was found. Fundus autofluorescece lifetimes in diabetic patients without MacTel were significantly shorter within the MacTel zone and longer in the periphery compared with diabetic patients with MacTel. CONCLUSION Although MacTel has a high prevalence of diabetes, FLTs from the MacTel zone are unrelated to diabetes. Fluorescence lifetime imaging ophthalmoscopy retains diagnostic abilities in patients with MacTel even in the presence of prediabetes, diabetes, and advanced diabetic retinopathy. The lack of diabetic FLT changes in the periphery of diabetic patients with MacTel is an interesting finding that needs further investigation.
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Affiliation(s)
- Lydia Sauer
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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Reddy NG, Prabhu V, Sharma SV, Acharya I, Mangla R, Yadav NK, Chhablani J, Narayanan R, Venkatesh R. Baseline demographic, clinical and multimodal imaging features of young patients with type 2 macular telangiectasia. Int J Retina Vitreous 2023; 9:47. [PMID: 37559099 PMCID: PMC10413760 DOI: 10.1186/s40942-023-00485-6] [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: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Macular telangiectasia (MacTel) type 2 is observed in patients in their 5th-8th decades of life. The clinical and imaging findings in younger patients is unknown in larger cohorts. The study purpose is to report prevalence, baseline clinical and spectral domain optical coherence tomography (SDOCT) findings in young MacTel patients below 40 years. METHODS This hospital-based, multicentre, retrospective, cross-sectional study included patients between 2011 and 2023. Retinal photographs from multiple imaging techniques were evaluated to diagnose and stage type 2 MacTel and describe their SDOCT findings. Imaging characteristics were correlated with clinical stages and visual acuity. RESULTS Among all MacTel patients seen in hospital, prevalence of young MacTel cases less than age 40 was 1.77% (32/1806; 62 eyes). Youngest participant was 34 years, while mean age was 38.44 ± 1.795 years. Sixteen patients (50%) were diabetics. Perifoveal greying (n = 56, 90%) and perifoveal hyperreflective middle retinal layers (n = 47, 76%) were the most prevalent clinical and SDOCT imaging finding respectively. Less than 10% (n = 6) eyes had proliferative disease. Presence of retinal pigment clumps (RPC) (7% vs. 67%; p = 0.002) coincided with proliferative MacTel. Poor vision was associated with presence of outer retinal layer SDOCT findings like outward bending of inner retinal layers (p = 0.047), RPC (p = 0.007), subfoveal neurosensory detachment (p = 0.048) and subretinal neovascular membrane (p = 0.001). CONCLUSION Type 2 MacTel before age 40 is rare, common in women and diabetics, and affects vision in advanced stage. Disease symmetry, comparison with older cases, and longitudinal SDOCT changes in such patients require further study.
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Affiliation(s)
- Nikitha Gurram Reddy
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Vishma Prabhu
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Sumanth Vinayak Sharma
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Isha Acharya
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Rubble Mangla
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
| | - Raja Narayanan
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Indian Health Outcomes, Public Health and Economics Research Centre (IHOPE), Kallam Anji Reddy Campus, Hyderabad, 500034, India.
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India.
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Yu JY, Jeong DE, Joo JY, Kim ST. Brain-derived neurotrophic factor levels and macular ganglion cell-inner plexiform layer thickness in macular telangiectasia type 2. Int Ophthalmol 2022; 43:1927-1933. [DOI: 10.1007/s10792-022-02592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
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Agarwal A. Co-existing retinal pathologies: Diagnostic challenges in diabetic retinopathy. Indian J Ophthalmol 2021; 69:2931. [PMID: 34708725 PMCID: PMC8725074 DOI: 10.4103/ijo.ijo_2504_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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van Romunde SHM, van der Sommen CM, Martinez Ciriano JP, Vingerling JR, Yzer S. Prevalence and Severity of Diabetic Retinopathy in Patients with Macular Telangiectasia Type 2. Ophthalmol Retina 2021; 5:999-1004. [PMID: 33444807 DOI: 10.1016/j.oret.2021.01.002] [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: 09/12/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the prevalence and severity of diabetic retinopathy (DR) in patients with macular telangiectasia type 2 (MacTel 2). DESIGN Retrospective case series. PARTICIPANTS Patients with a diagnosis of MacTel 2 treated at the Rotterdam Eye Hospital or Erasmus Medical Center between 2014 and 2018 were included. METHODS The following information was retrieved from patient files: demographics, history of diabetes mellitus and hypertension, presence of DR, and severity of DR, that is, mild, moderate, severe, or proliferative. Presence of diabetic macular edema (DME) was assessed using OCT. MAIN OUTCOME MEASURES Presence and severity of DR. RESULTS Two hundred six eyes of 103 patients were included. At the onset of MacTel 2, the mean age was 61 years (standard deviation [SD], 9.8 years) and 64 (62%) were women. Mean follow-up was 71 months (SD, 60 months). Diabetes mellitus type 2 was present in 50 patients (49%) and hypertension was present in 47 patients (46%). Mild DR was present in 22 eyes (11%), of which 14 eyes (7%) showed signs at baseline and 8 eyes (4%) showed signs at a later time during follow-up. Ten eyes (5%) demonstrated remission of mild DR during follow-up. Both eyes (1%) in 1 patient progressed to moderate DR. Severe DR, proliferative DR, and DME did not occur. CONCLUSIONS Although diabetes mellitus was highly prevalent among MacTel 2 patients, no patients showed severe or proliferative DR or DME. These findings suggest that MacTel 2 could have a protective effect on the progression of DR. We hypothesize that our results may be explained by the role of Müller cells in the development of MacTel 2 and DR, and therefore a link between both diseases warrants additional studies.
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Affiliation(s)
| | | | | | | | - Suzanne Yzer
- Rotterdam Eye Hospital, Rotterdam, The Netherlands
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Retinal vascular density evaluated by optical coherence tomography angiography in macular telangiectasia type 2. Int Ophthalmol 2019; 39:2245-2256. [PMID: 30607862 DOI: 10.1007/s10792-018-01060-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the retinal and choroidal vascular changes through optical coherence tomography angiography (OCTA) in patients with macular telangiectasia type 2 (MacTel 2). METHODS Our study included 20 patients (40 eyes) with MacTel 2, and age-matched and sex-matched 18 subjects (36 eyes) in the control group. Fundus color photographs, fundus autofluorescence, fundus fluorescein angiography, spectral-domain optical coherence tomography and OCTA were performed. Foveal vascular density and parafoveal vascular density (PFVD), and foveal retinal thickness and parafoveal retinal thickness, choroidal thickness (CT) and retinal ganglion cell-inner plexiform layer (GCIPL) were compared between MacTel 2 patients and normal age-matched controls. RESULTS The retinal whole vascular density and PFVD of the deep plexus were significantly lower in patients with MacTel 2 than that of the control group (56.93% vs. 58.54%, p = 0.003; and 60.38% vs. 61.66%, p = 0.045). The foveal avascular zone (FAZ) of the deep plexus was significantly enlarged in patients with MacTel 2 than that of the control group (0.44 vs. 0.36, p = 0.009). There was a positive and statistically significant correlation between the FAZ of the superficial and deep plexus and CT in patients with MacTel 2. There was a positive and statistically significant correlation between retinal whole, parafoveal temporal quadrant vascular density of the superficial and deep plexus and GCIPL thickness in patients with MacTel 2. CONCLUSIONS Our study demonstrated that important retinal vascular density and FAZ changes in MacTel 2 occur in the deep capillary plexus of the retina.
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