Non-proliferative type II macular telangiectasia variant with subfoveal detachment: role of anti-VEGF therapy

To describe a rare variant of non-proliferative stage of type II macular telangiectasia (MacTel2) with the presence of subfoveal detachment (SFD) and its response to intravitreal antivascular endothelial growth factor (VEGF) therapy.

A retrospective case series of patients diagnosed with a rare variant of non-proliferative MacTel2 (defined as MacTel2 with the presence of SFD on optical coherence tomography (OCT) in the absence of subretinal neovascularisation, confirmed on fluorescein angiography (FA)) over a period of 2 years. Patients were studied with biomicroscopy, OCT and FA. Patients were managed either with observation or anti-VEGF therapy.

Twenty eyes of 13 patients, all female with a mean age of 52.2±6.1 years, were diagnosed with this variant of non-proliferative MacTel2. The best-corrected visual acuity at presentation ranged from 20/20 to 20/120. Six eyes were lost to follow-up. Eight eyes were kept under observation for a mean follow-up of 7.3±2.2 months and did not show resolution. Eight eyes underwent anti-VEGF therapy with a mean number of intravitreal injections of 2±1.07 per eye during a mean follow-up of 9.38±5.5 months. All eyes showed complete resolution of SFD, with a visual improvement of ≥1 line of Snellen's acuity in 87.5% of the eyes.

This is the largest series of a variant of non-proliferative MacTel2 with SFD, which shows good anatomical and functional response to anti-VEGF therapy, in comparison to observation alone. Careful evaluation of the OCT images may be helpful in predicting the visual prognosis with anti-VEGF therapy.