Intravitreal Bevacizumab for Treatment of Proliferative and Nonproliferative Type 2 Idiopathic Macular Telangiectasia

Roller, Aaron Brock; Folk, James C.; Patel, Neelam; Boldt, H. Culver; Russell, Stephen R.; Abràmoff, Michael D.; Mahajan, Vinit B.

doi:10.1097/iae.0b013e31820d3feb

Cited by 50 publications

(38 citation statements)

References 41 publications

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“…Both a staining effect and minimal leakage have been considered as possible explanations [3,4,13]. Recently, it has been hypothesized that VEGF may play an essential role in IMT, which has stimulated the use of bevacizumab or ranibizumab for the treatment of this condition (table 2) [2,3,4,5,6,7,8,9,10,11,12]. Even though some authors have shown a significant visual effect [3,4,5,9,10], others have reported no significant functional improvement after intravitreal anti-VEGF treatment despite apparent anatomical changes in the decreased late-phase FA leakage and decreased CRT on OCT [6,7].…”

Section: Discussionmentioning

confidence: 99%

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Intravitreal Bevacizumab for Type 2 Idiopathic Macular Telangiectasia

Veloso

Vianna²,

Pelayes³

et al. 2013

Ophthalmic Res

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Background/Aims: The aim of this paper is to report the treatment of type 2 nonproliferative idiopathic macular telangiectasia (IMT) with intravitreal bevacizumab (IVB). Methods: Retrospective case series of 10 eyes of 5 patients with type 2 IMT. All patients received 3 monthly IVB injections. Visual acuity (VA), fluorescein angiography (FA) and optical coherence tomography (OCT) were performed at baseline and 4 weeks after each injection. Results: Four weeks after the third IVB injection, VA remained stable for all patients. All eyes showed some decrease in fluorescein leakage, and there was a mild decrease in central macular thickness. One year later, VA, OCT and FA findings returned to the baseline levels. Conclusion: IVB did not improve VA in cases of type 2 IMT.

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Section: Discussionmentioning

confidence: 99%

“…Recently, type 2 IMT has been treated with anti-vascular endothelial growth factor (VEGF) agents with different results [2,3,4,5,6,7,8,9,10,11,12]. The purpose of this study is to describe a case series of patients treated with intravitreal bevacizumab (IVB) for type 2 IMT.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Bevacizumab for Type 2 Idiopathic Macular Telangiectasia

Veloso

Vianna²,

Pelayes³

et al. 2013

Ophthalmic Res

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“…The pathognomonic empty spaces in OCT have been suspected to represent the loss of retinal tissue rather than intraretinal fluid accumulation caused by leakage of telangiectatic vessels [21,39]. …”

Section: Discussionmentioning

confidence: 99%

“…This has previously led to the hypothesis that VEGF acts as a pivotal mediator in the pathophysiology of MacTel type 2 [20,21]. Indeed, a prospective study evaluating monthly ranibizumab injections for nonproliferative MacTel type 2 could demonstrate a distinct reduction of leakage in FA.…”

Section: Introductionmentioning

confidence: 99%

Reduced-Fluence Photodynamic Therapy Combined with Ranibizumab for Nonproliferative Macular Telangiectasia Type 2

Zehetner¹,

Haas²,

B³

et al. 2013

Ophthalmologica

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Purpose: To report the efficacy of reduced-fluence photodynamic therapy (PDT) combined with intravitreal ranibizumab for the treatment of nonproliferative macular telangiectasia (MacTel) type 2. Methods: Noncomparative, interventional, retrospective case series; 5 eyes of 4 patients were studied. Patients were treated with reduced-fluence PDT and intravitreal ranibizumab within 24 h. After initial treatment, follow-up was at least 12 months in all patients. Results: At baseline median logMAR (logarithm of the minimal angle of resolution) best-corrected visual acuity (BCVA) was 1.0 (range, 1.0-0.3). At 3 months of follow-up vision increased in 3 out of 5 eyes and median BCVA was 0.4 (range, 1.0-0.2). The gain of BCVA ranged from 6 lines to 1 line. Visual acuity remained stable in the other 2 study eyes. No eyes lost vision at 3 months of follow-up. At 12 months of follow-up median logMAR BCVA was 0.7 (range, 1.3-0.3). Two eyes had maintained their gain in BCVA compared to baseline. Two eyes lost vision compared to baseline and 1 eye showed unchanged visual acuity at 12 months of follow-up. Conclusion: A combination therapy with reduced-fluence PDT and intravitreal ranibizumab might be a valuable treatment option for eyes with progressive vision loss due to nonproliferative MacTel type 2.

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“…The concept of a similar pathogenesis of neovascular AMD and MacTel type 2 was the rationale to study VEGF-inhibitors as a treatment option for neovascular MacTel type 2 ( Fig. 10; Charbel Issa et al, 2007b;Jorge et al, 2006;Karagiannis et al, 2009;Konstantinidis et al, 2009;Mandal et al, 2007;Mondal et al, 2010;Roller et al, 2011;Ruys et al, 2007;Shanmugam et al, 2007). Jorge and co-workers were the first to show a positive effect of bevacizumab in a patient with a juxtafoveolar neovascular membrane .…”

Section: Proliferative Stagementioning

confidence: 99%

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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Intravitreal Bevacizumab for Treatment of Proliferative and Nonproliferative Type 2 Idiopathic Macular Telangiectasia

Abstract: Bevacizumab did not improve acuity or reduce retinal thickness in nonproliferative macular telangiectasia Type 2 at final follow-up. In proliferative macular telangiectasia Type 2, bevacizumab caused involution of neovascularization and improved visual acuity.

Cited by 50 publications

References 41 publications

Intravitreal Bevacizumab for Type 2 Idiopathic Macular Telangiectasia

Intravitreal Bevacizumab for Type 2 Idiopathic Macular Telangiectasia

Reduced-Fluence Photodynamic Therapy Combined with Ranibizumab for Nonproliferative Macular Telangiectasia Type 2

Macular Telangiectasia Type 2

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