Aim To report the natural history of subretinal fluid (SRF) causing foveal detachment in macular telangiectasia type 2 (MacTel) and our experience of therapeutic intervention with intravitreal steroids or antivascular endothelial growth factor inhibitor (anti-VEGF) agents in some cases.
Methods Retrospective case series. Three of the MacTel study's largest registries were searched to identify eyes with foveal detachment.
Results We identified 7 eyes from 6 exclusively female patients. The prevalence of foveal detachment was low, present in 1.4% of the assessed MacTel population. Age at presentation ranged from 50 to 66 years. Follow-up ranged from 2 to 8 years. There was late-phase leakage on fluorescein angiography from what was presumed to be ectatic capillaries. The SRF fluctuated without a rapid decline in visual acuity in cases that were not treated. When they were, intravitreal anti-VEGF and steroid therapy in general reduced SRF, at least temporarily, but did not halt the gradual long-term decrease in visual acuity. In one case, optical coherence tomography angiography showed significant reduction in the extent of the predominantly deep intraretinal vascular complex 1 month after anti-VEGF therapy.
Discussion and conclusions As the natural history of this unusual MacTel phenotype is not characterised by rapid visual decline, intervention with intravitreal anti-VEGF or steroid therapy may not be necessary.
- Treatment other
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Contributors Study concept and design: MCG. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: HM. Critical revision of the manuscript for important intellectual content: all authors. Obtained funding: MCG, CAE and FGH. Study supervision: MCG, CAE and PCI.
Funding Supported by the Lowy Medical Research Institute (The Macular Telangiectasia Project, www.mactelresearch.com).
Competing interests None declared.
Ethics approval Local Institutional Review Board approval was granted from the human research ethics committees of South Eastern Sydney Local Health District, Moorfields Eye Hospital and the Medical Faculty of Rheinische Friedrich-Wilhelms at the University of Bonn.
Provenance and peer review Not commissioned; externally peer reviewed.