Name

Cas atypique de télangiectasies maculaires type 1 bilatérales

To report an unusual case of type 1A idiopathic macular telangiectasia (IMT).

We report the case of a 54-year-old female with a bilateral cystoid macular edema revealing a type 1 A idiopathic macular telangiectasia. 

A 54-year-old female presented with gradual vision loss in both eyes. Best-corrected visual acuity (BCVA) was limited to counting figures 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 the macular telangiectasia. Macular swept-source optical coherence tomography (SS-OCT) showed bilateral cystoid macular edema 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.

We described a case of a bilateral type 1A IMT, affecting a middle-aged woman, without peripheral involvement. Usually, this entity is unilateral 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, it had its limits. In fact, compared to FA, some vascular abnormalities were undetectable, it was probably due to a turbulent or low blood flow in these abnormalities.

type 1 telengiectasia can be revealed with bilateral cystoid macular edema. Multimodal imaging is mendatory to evaluate its impact on retina and choroid.