Macular Telangiectasia Type 2 With Bidirectional Neovascular Network

To report a novel presentation of macular telangiectasia type 2 (MacTel-2) with bidirectional vascular network extending as both epiretinal and subretinal neovascularisation in the setting of proliferative diabetic retinopathy.

Case report.

A 45-year-old female presented with progressive diminution of vision in both eyes (BE) over 5 years. She had a history of diabetes mellitus for 10 years and had previously received intravitreal anti-vascular endothelial growth factor (VEGF) injections for Diabetic macular edema. Her best corrected visual acuity(BCVA) was 6/18 in right eye (RE) and 6/12 in left eye (LE). The anterior segment was normal. Fundus examination showed bilateral macular pigment clumping with foveal neovascularisation and neovascularisation elsewhere (NVE) with preretinal hemorrhage due to proliferative diabetic retinopathy (PDR) despite prior panretinal photocoagulation. Multimodal imaging, including Fluorescein, Indocyanine green and OCT angiographies, demonstrated bilateral epiretinal, intra-retinal and subretinal macular neovascularisation in macular telangiectasia type 2 (MacTel-2 ) in the setting of PDR.

This case highlights a rare and unique presentation of MacTel-2 with multilayered macular neovascular proliferation in the setting of proliferative diabetic retinopathy, which has not been reported previously. It emphasises the utility of multimodal imaging, especially OCTA, in diagnosing complex neovascular patterns in patients with overlapping retinal pathologies.