Aims To identify morphological characteristics preceding the development of exudative neovascularisation secondary to Macular Telangiectasia type 2 (MacTel) using multimodal retinal imaging.
Methods In this retrospective study, eyes with a minimum observation period of 6 months prior to the de novo diagnosis of an exudative neovascularisation secondary to MacTel were analysed. Morphological changes preceding the formation of neovascularisation were evaluated using colour fundus photography, infrared imaging, fluorescein angiography, macular pigment measurement and optical coherence tomography (OCT). OCT-angiography (OCT-A) images were additionally available in a subset of patients.
Results Twenty eyes from 20 patients were examined over a median period of 17 months (range: 6–100 months). Eyes were characterised by an accelerated progression of ellipsoid zone loss (median of 0.013 mm2/month), increased thickness of the temporal parafovea and hyper-reflective lesions on OCT. The latter underwent morphological changes preceding the development of exudative neovascularisation, including an increase in size and density, and expansion to outer retinal layers and the retinal pigment epithelium. All eyes showed a foveal depletion of macular pigment. On OCT-A, a focal increase in blood flow was observed at the level of the outer retina/choriocapillaris, and retinal–retinal and retinal–choroidal anastomoses preceded the formation of exudative neovascularisation.
Conclusions Multimodal imaging allows the identification of prognostic morphological features preceding the formation of exudative neovascularisation in MacTel. Eyes exhibiting these characteristics should be monitored closely and patients should be alert for emergent symptoms in order to detect and treat neovascularisation early and, thereby, prevent irreversible visual loss.
Data availability statement
All data relevant to this study are included in the article or uploaded as supplementary information.
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Contributors KH: data acquisition, data analysis and interpretation; writing—original draft preparation; writing—review and editing; PCI: critical revision of the work for important intellectual content; writing—review and editing; FGH: critical revision of the work for important intellectual content; writing—review and editing; ST: study design, data analysis and interpretation; writing - review and editing. All authors have read and agreed to the published version of the manuscript.
Funding This work was supported by The Lowy Medical Research Institute. KH received a BONFOR Gerok Grant, grant number 2019-1A-13 from the University of Bonn, Bonn, Germany.
Competing interests The Department of Ophthalmology, University of Bonn, received technical support from Heidelberg Engineering, Heidelberg, Germany and Carl Zeiss Meditec, Jena, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.
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