Epiretinal neovascular membrane in Macular Telangiectasia type 2: Multimodal imaging diagnosis

To characterize an epiretinal neovascular membrane (ERNM) through multimodal imaging in the context of a patient with Macular Telangiectasia type 2 (MacTel) and ipsilateral concomitant ocular ischemic syndrome (OIS).

Case report, with ultra-wide field (UWF) retinography, fluorescein angiography (FA), swept source optical coherence tomography (ss-OCT), and OCT-angiography (OCTA). Written informed consent for patient information and images to be published was provided by the patient. Approval from the Research Ethics Committee of the Hospital was obtained for publication.

Yearly follow up of a 51 year-old-female patient with advanced bilateral MacTel showed new punctate hemorrhages in all four quadrants of her right eye (OD). OCTA showed an ERNM in the superficial capillary plexus of the same eye and FA confirmed the ERNM and demonstrated peripheral ischemia. Carotid ultrasound was performed and complete right carotid artery occlusion was confirmed. These findings allowed the diagnosis of an ERNM associated with Mactel and OIS.

Interestingly, this case shows an ERNM diagnosed by multimodal imaging in a patient with advanced MacTel and a concomitant OIS. Mactel is a neurodegenerative disease which in its neovascular stage has been associated with macular neovascular membranes, but also ERNM have recently been described by OCTA.