Combined photodynamic therapy and intravitreal ranibizumab as primary treatment for subretinal neovascular membrane (SRNVM) associated with type 2 idiopathic macular telangiectasia

Rishi, Pukhraj; Shroff, Daraius; Rishi, Ekta

doi:10.1007/s00417-007-0732-0

Cited by 23 publications

(20 citation statements)

References 11 publications

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“…Combined PDT and intravitreal ranibizumab injection was reported in two case reports. An improvement of visual acuity from 20/125 to 20/60 and stabilization thereafter was achieved within a follow up period of 9 months in one patient (Rishi et al, 2008) and stabilization was achieved in the second patient . Only one PDT treatment with either one (Rishi et al, 2008) or two intravitreal injections were necessary.…”

Section: Proliferative Stagementioning

confidence: 86%

“…Few cases of MacTel type 2 treated with PDT combined with an intravitreal injection of either triamcinolone (Smithen and Spaide, 2004) or ranibizumab (Rishi et al, 2008;Ruys et al, 2007) have been reported. Combined PDT and intravitreal triamcinolone for neovascular MacTel type 2 resulted in an increase of visual acuity from 20/200 to 20/50 (Smithen and Spaide, 2004).…”

Section: Proliferative Stagementioning

confidence: 99%

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Macular Telangiectasia Type 2

Heeren

Holz

Issa

2013

Microperimetry and Multimodal Retinal Imaging

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Macular telangiectasia type 2 is a bilateral disease of unknown cause with characteristic alterations of the macular capillary network and neurosensory atrophy. Its prevalence may be underestimated and has recently been shown to be as high as 0.1% in persons 40 years and older. Biomicroscopy may show reduced retinal transparency, crystalline deposits, mildly ectatic capillaries, blunted venules, retinal pigment plaques, foveal atrophy, and neovascular complexes. Fluorescein angiography shows telangiectatic capillaries predominantly temporal to the foveola in the early phase and a diffuse hyperfluorescence in the late phase. High-resolution optical coherence tomography (OCT) may reveal disruption of the photoreceptor inner segment-outer segment border, hyporeflective cavities at the level of the inner or outer retina, and atrophy of the retina in later stages. Macular telangiectasia type 2 shows a unique depletion of the macular pigment in the central retina and recent therapeutic trials showed that such depleted areas cannot re-accumulate lutein and zeaxanthin after oral supplementation. There have been various therapeutic approaches with limited or no efficacy. Recent clinical trials with compounds that block vascular endothelial growth factor (VEGF) have established the role of VEGF in the pathophysiology of the disease, but have not shown significant efficacy, at least for the nonneovascular disease stages. Recent progress in structure-function correlation may help to develop surrogate outcome measures for future clinical trials.In this review article, we summarize the current knowledge on macular telangiectasia type 2, including the epidemiology, the genetics, the clinical findings, the staging and the differential diagnosis of the disease. Findings using retinal imaging are discussed, including fluorescein angiography, OCT, adaptive optics imaging, confocal scanning laser ophthalmoscopy, and fundus autofluorescence, as are the findings using visual function testing including visual acuity and fundus-controlled microperimetry. We provide an overview of the therapeutic approaches for both non-neovascular and neovascular disease stages and provide a perspective of future directions including animal models and potential therapeutic approaches.

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Section: Proliferative Stagementioning

confidence: 86%

Section: Proliferative Stagementioning

confidence: 99%

Macular Telangiectasia Type 2

Heeren

Holz

Issa

2013

Microperimetry and Multimodal Retinal Imaging

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“…Primary treatment with combined intravitreal injections of bevacizumab (1.25 mg) [88] or ranibizumab (0.5 mg) and PDT [89] were also reported with an improvement of VA and regression of SRNV confirmed by clinical, FA and OCT findings.…”

Section: Retinal Telangiectasiasmentioning

confidence: 98%

“…Generally, it is unilateral, and appears in males with no racial predilection [88,89] around the fourth decade of life. The most frequent localization is the temporal hemiretina between the posterior pole and the peripheral retina.…”

Section: Leber’s Miliary Aneurysmmentioning

confidence: 99%

Primitive Retinal Vascular Abnormalities: Tumors and Telangiectasias

et al. 2012

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Primitive retinal vascular abnormalities are benign conditions of the retinal circulation that comprise vascular tumors and telangiectasias. The principal vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, racemose hemangiomatosis of the retina and retinal vasoproliferative tumor, while primary retinal telangiectasias include Coats’ disease, Leber’s miliary aneurysms and idiopathic juxtafoveal telangiectasias. In most cases, these alterations result in significant visual impairment due to exudation determined by the structural abnormalities of the retinal vasculature. The aim of this review is to assess the different clinical and diagnostic features of the single pathological entities and to discuss the available treatment modalities including the onset of intravitreal antivascular endothelial growth factor therapy.

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“…Recently, several studies have shown favorable functional and anatomic results using the off-label anti-VEGF-A drug bevacizumab in the treatment of PIJT [3,6,7]. In 2008, Rishi et al reported a case of PIJT that underwent primary treatment with a combination of photodynamic therapy (PDT) and intravitreal ranibizumab that demonstrated functional improvement [8]. In our case, treatment with three monthly interval intravitreal injections of ranibizumab resulted in an improvement of BCVA and complete resolution of SRNV during the follow-up period.…”

mentioning

confidence: 97%