An unusual case of bilateral type 1 idiopathic macular telangiectasia

Abstract

Purpose: To report an unusual case of Type 1A idiopathic macular telangiectasia (IMT).Methods: A single case presentation.Results: A 54‐year‐old female presented with gradual vision loss in both eyes. Best‐corrected visual acuity (BCVA) was limited to counting fingers in both eyes. Fundus examination showed bilateral hard macular exudates associated with small macular telangiectasia. Fluorescein angiography (FA) revealed early bilateral macular punctuated hyperfluorescence corresponding to macular telangiectasia. Macular swept‐source optical coherence tomography (SS‐OCT) showed bilateral cystoid macular oedema associated with serous retinal detachment. OCT‐angiography (OCT‐A) showed clearly some of the perifoveal aneurysmal dilations and telangiectasia. Based on these findings, the patient was diagnosed with bilateral type 1A IMT according to Gass and Blodi classification and was treated with intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) injections. Three months later, SS‐OCT revealed partial regression of the exudative signs and BCVA improvement.Conclusions: We described a case of a bilateral Type 1A IMT, affecting a middle‐aged woman, without peripheral involvement. Usually, this entity is unilateral and evolving the mid periphery. Macular SS‐OCT helped to visualize the extent of retinal involvement in the presence of masking macular hard exudates. OCT‐A visualized some of the telangiectasias however, compared to FA, some vascular abnormalities were undetectable, probably due to a turbulent or low blood flow. Treatment with intravitreal Anti‐VEGF can lead to incomplete response.