✍️irregular dilation of the capillary bed and segmental dilation of neighbouring venules and arterioles
✍️ Most commonly acquired secondary to another retinal disorder
✍️ primary forms also exist
✅ Retinal telangiectasias Causes:
✍️ primary
☝️ Congenital
• Coats’ disease
• Leber’s miliary aneurysms
• MacTel type 1
☝️ Acquired
• MacTel type 2
✍️ secondary
☝️ BRVO
☝️ Diabetic retinopathy
☝️ Ocular inflammatory disease
☝️ Eales’ disease
☝️ ROP
☝️ Sickle retinopathy
☝️Radiation retinopathy
🌗 MacTel type 1
✍️idiopathic juxtafoveal retinal telangiectasia type1
✍️ described by gass in 1968
✍️ developmental or congenital
✍️ usually unilateral
✍️ commoner in male ( 10:1 ratio )
✍️ may represent a mild variant of Coats’ syndrome and Leber’s miliary aneurysms.
Clinical picture of (MacTel type 1)
✍️ Visible aneurysmal dilation of retinal vasculature
✍️ mainly confined to an irregular or oval zone in the temporal macula
✍️ surrounding CMO
✍️ yellowish exudates (in patients with diabetes, this may be mistaken for DMO).
✍️ characteristic loss of central macular pigment
Treatment of MacTel type1
✍️ Direct laser photocoagulation of aneurysms decrease
☝️ vascular exudation
☝️ improve VA.
✍️ use of intravitreal triamcinolone and anti-VEGF monotherapy has proven disappointing (small case series).
🌗 MacTel type 2
✍️ idiopathic juxtafoveal retinal telangiectasia type 2
✍️ described by gass in 1977
✍️ acquired
✍️ bilateral
✍️ in middle-aged and older patients.
✍️ equal in male and female
Clinical picture of MacTel type2
✍️ dropped VA
✍️ paracentral scotomas
✍️ metamorphopsia
✍️ vision-related quality of life is markedly reduced .
✍️ Bilateral
✍️ occasionally asymmetric
✍️ begin temporal to the foveal centre but subsequently involves entire parafoveolar area.
✍️ reduced retinal transparency (greying)
✍️ dilatation of retinal capillaries
✍️ crystalline deposits at the vitreoretinal interface.
✍️ Blunted, dilated venules develop adjacent to ectatic capillaries and dive down the choroid at right-angle
✍️ RPE hyperplasia and intraretinal pigment migration
✍️ subretinal neovascularization may develop.
Investigations for MacTel type 2
✍️ FAF
☝️ characteristic loss of hypo fluorescent foveal centre(seen normally with blue-light FAF)due to loss of central macular pigment.
✍️ FFA
☝️ characteristic telangiectatic capillaries temporal to the fovea
☝️ early characteristic retinal leakage limited to the central macula and often more pronounced temporally.
☝️ Signs of 2ry CNV, if present.
✍️ OCT
☝️ characteristic hyporeflective retinal cavities
☝️ normal or subnormal retinal thickness despite angiographic leakage
☝️ disruption of photoreceptor IS-OS junction
☝️ hyperre ective intra- or subretinal lesions (pigment migration or neovascularization)
☝️ in late stages lamellar or full-thickness macular holes occasionally occur.
Treatment
✍️ no generally accepted therapies for MacTel type 2 not associated with neovascularization.
☝️ In patients with subretinal neovascularization, anti-VEGF therapies are commonly used( evidence for efficacy is limited).
🌗 DDx of retinal telangectasia
✍️ diabetes
✍️ vein occlusion
✍️ radiation retinopathy
✍️ Coats disease
✍️ Eales’ disease
✍️ Best disease
✍️ sickle cell
✍️ Irvine-Gass syndrome
✍️ ocular ischemia
🌗 Complications of retinal telangectasia
✍️ macular edema
✍️ exudates
✍️ CNV
✍️ intraretinal neovascularization
✍️ macular hole
