Manoj S, Sameer I*, Ravi RV, Mancy Mathew and Narendra Meel

Chaithanya Eye Hospital and Research Institute, Thiruvananthapuram, Kerala, India

*Corresponding Author: Sameer I, Department of Vitreo-Retinal Service, Chaithanya Eye Hospital and Research Institute, Thiruvananthapuram, Kerala, India.

Received: November 29, 2022; Published: December 13, 2022

Abstract

Purpose: The purpose of this study was to study the clinico-demographic characteristics of Mactel patients and to correlate its clinical findings with FFA and OCT findings.

Methods: This prospective study was conducted in 30 Mactel patients at a tertiary eye care centre in south Kerala between May 2014 and May 2016. Clinical staging of the disease was done based on Gass and Blodi classification. In FFA, disease was classified into those with < 180 degrees leakage, > 180 degrees leakage and CNVM leakage. OCT findings were also noted. Routine blood investigations were carried out in all the patients. These were arbitrarily divided into convenient groups for the statistical analysis.

Results: The mean age of MacTel patients was 57 years with a female predominance in study group. Out of this, 86.71% had overt diabetes mellitus, 36.67% had hypertension and 16.7% had familial hypercholesterolemia. Most of the patients had stage 2 disease (48.33%) while none of them had Stage 1 disease. 46.67% in the study had < 180 degrees leakage on FFA while 48.33% had > 180 degrees. 3 eyes (5%) had CNVM type of leakage. Degree of leakage on FFA tended to correlate with the stage of disease. Common OCT findings were normal OCT (43.3%), Inner Lamellar Hole in 23.33%, Outer Lamellar Hole in 15%, full thickness hole in 1.67%, foveal pigmentation in 11.67% and CNVM in 5%. However central foveal thickness did not show a correlation with vision loss.

Conclusion: The coexistence of high prevalence of diabetes mellitus and hypertension was suggestive of the fact that the vascular stress in these conditions may add to the pathogenesis of Mactel. Further research is required to establish the significance of the higher prevalence of dyslipidemia in Mactel l patients as found in our study. As the disease progresses, the degree of FFA leakage seems to suggest greater disease severity. OCT characteristics, however, failed to demonstrate such a correlation. Central foveal thickness in OCT may not be a good index to correlate with visual prognosis in these patients.

Keywords: Macular Telangiectasia, Mactel; Systemic Associations; Fundus Fluorescein Angiography; Optical Coherence Tomography

References

1. Charbel Issa P., et al. “Macular telangiectasia type 2”. Progress in Retinal and Eye Research 34 (2013): 49-77.
2. Gass JD and Blodi BA. “Idiopathic juxtafoveolar retinal telangiectasis. Update of classification and follow-up study”. Ophthalmology 10 (1993): 1536-1546.
3. Elias A., et al. “Risk factors in patients with macular telangiectasia 2A in an Asian population: A case-control study”. Indian Journal of Ophthalmology9 (2017): 830-834.
4. Klein R., et al. “The prevalence of macular telangiectasia type 2 in the Beaver Dam eye study”. American Journal of Ophthalmology1 (2010): 55-62.
5. Gaudric A., et al. “Optical coherence tomography in group 2A idiopathic juxtafoveolar retinal telangiectasis”. Archives of Ophthalmology10 (2006): 1410-1419.
6. Yannuzzi LA., et al. “Idiopathic macular telangiectasia”. Archives of Ophthalmology4 (2006): 450-460.
7. Gass JD and Oyakawa RT. “Idiopathic juxtafoveolar retinal telangiectasis”. Archives of Ophthalmology5 (1982): 769-780.
8. Marsonia K., et al. “Long term follow-up of visual acuity and incidence of subretinal neovascularization in Mactel type 2 in 82 eyes”. Seminar on Ophthalmology2 (2022): 136-141.
9. Chew EY., et al. “Parafoveal telangiectasis and diabetic retinapathy”. Archives of Ophthalmology 104 (1986): 71-75.
10. AR Chokshi., et al. “Clinical Characteristics and Correlation of Stage of Disease to Visual Acuity in Type II Idiopathic Juxtafoveal Telangiectasia”. Investigative Ophthalmology and Visual Science 43 (2002): 511.
11. Gillies MC., et al. “Familial asymptomatic macular telangiectasia type 2”. Ophthalmology 12 (2009): 2422-2429.
12. Paunescu LA., et al. “Idiopathic juxtafoveal retinal telangiectasis: new findings by ultrahigh-resolution optical coherence tomography”. Ophthalmology1 (2006): 48-57.
13. Olson JL and Mandava N. “Macular hole formation associated with idiopathic parafoveal telangiectasia”. Graefe's Archive for Clinical and Experimental Ophthalmology 3 (2006): 411-412.
14. Pauleikhoff D., et al. “Imaging endpoints for clinical trials in MacTel type 2”. Eye2 (2022): 284-293.
15. Cohen SM., et al. “Optical coherence tomography findings in nonproliferative group 2a idiopathic juxtafoveal retinal telangiectasis”. Retina 1 (2007): 59-66.
16. Charbel Issa P., et al. “Macular telangiectasia”. In: Holz FG, Spaide RF (eds). Medical retina. Springer, Heidelberg (2007): 183-197.
17. Venkatesh R., et al. “Spectral domain OCT features in type 2 macular telangiectasia (type 2 MacTel): its relevance with clinical staging and visual acuity”. International Journal of Retina and Vitreous 8 (2022): 26.
18. Kovach JL and Rosenfeld PJ. “Bevacizumab (avastin) therapy for idiopathic macular telangiectasia type II”. Retina1 (2009): 27-32.
19. Kupitz EH., et al. “Poor longterm outcome of anti-vascular endothelial growth factor therapy in nonproliferative macular”. Retina 35 (2015): 2619-2626.
20. Narayanan R., et al. “Efficacy of anti-vascular endothelial growth factor therapy in subretinal neovascularization secondary to macular telangiectasia type 2”. Retina10 (2012): 2001-2005.
21. Toygar O., et al. “Longterm outcomes of intravitreal bevacizumab therapy for subretinal neovascularization secondary to idiopathic macular telangiectasia type 2”. Retina11 (2016): 2150-2157.

Citation

Citation: Sameer I., et al. “Mactel Type 2: Evaluation of Systemic Associations and Imaging Characteristics".Acta Scientific Ophthalmology 6.1 (2023): 07-13.

Copyright

Copyright: © 2022 Sameer I., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.