Atypical bilateral presentation in idiopathic macular telangiectasia type 1

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Idiopathic macular telangiectasia type 1 (MacTel 1) is a rare retinal vascular disorder.
• It characteristically presents unilaterally, affecting central vision.

Observation:

• A 73-year-old male presented with atypical bilateral MacTel 1.
• The patient exhibited cystoid macular edema (CME).

Findings:

• Multimodal imaging, including optical coherence tomography angiography (OCTA), was crucial for differentiating MacTel 1 from MacTel 2.
• Dexamethasone implant treatment yielded limited efficacy for CME.
• Aflibercept therapy showed initial promise but was complicated by recurrences upon dose extension.

Implications:

• This case highlights the rare bilateral manifestation of MacTel 1.
• It underscores the diagnostic utility of advanced imaging techniques in retinal vascular diseases.
• The findings suggest a complex treatment response and potential for recurrence in MacTel 1 management.