Macular telangiectasia type 2 presenting with sub-internal limiting membrane hemorrhage

A 60-year-old female with recent-onset defective vision in her right eye (RE) was found to have presenting visual acuity of 20/320 with a sub-internal limiting membrane hemorrhage at the macula, which was cleared surgically. Postoperatively, visual acuity improved significantly to 20/30. Multimodal imaging revealed the characteristic features of macular telangiectasia (MacTel) type 2 in both eyes. Worsening of vision in the RE occurred at 1-year follow-up. Optical coherence tomography angiography revealed a network of subretinal new vessels in the RE, which was treated with intravitreal Avastin injection. A stable clinical course in both eyes was noted during subsequent follow-ups. A rare presentation of preretinal hemorrhage in the absence of a choroidal neovascular membrane as the first sign of MacTel type 2 was managed satisfactorily with surgical intervention.