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PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 11  |  Page : 840-842

Fluorescein angiography of subretinal neovascular membrane in parafoveal telangiectasia type II demonstrating retino-retinal, retino-subretinal anastomosis


1 Department of Retina and Uvea, Megur Eye Care Centre, Bidar, Karnataka, India
2 Department of Cataract and Glaucoma, Megur Eye Care Centre, Bidar, Karnataka, India
3 Department of Retina, Megur Eye Care Centre, Bidar, Karnataka, India

Date of Submission17-Jan-2016
Date of Acceptance13-Jun-2016
Date of Web Publication13-Dec-2016

Correspondence Address:
Bharathi Megur
Department of Retina and Uvea, Megur Eye Care Centre, Bidar, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.195600

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Keywords: Fluorescein angiography, parafoveal telangiectasia type II, retino-retinal and retino-subretinal anstomosis, subretinal neovascular membrane


How to cite this article:
Megur B, Megur D, Reddy S. Fluorescein angiography of subretinal neovascular membrane in parafoveal telangiectasia type II demonstrating retino-retinal, retino-subretinal anastomosis. Indian J Ophthalmol 2016;64:840-2

How to cite this URL:
Megur B, Megur D, Reddy S. Fluorescein angiography of subretinal neovascular membrane in parafoveal telangiectasia type II demonstrating retino-retinal, retino-subretinal anastomosis. Indian J Ophthalmol [serial online] 2016 [cited 2017 Apr 26];64:840-2. Available from: http://www.ijo.in/text.asp?2016/64/11/840/195600

Parafoveal telangiectasia is also known as juxtafoveal retinal telangiectasis or idiopathic perifoveal telangiectasia. Clinical features include loss of the macular luteo pigment in the temporal fovea (gray reflex), microaneurysms, right-angled venules, crystalline deposits, and subretinal neovascular membrane. Our photo essay shows the angiographic documentation of the retino-retinal and subretinal anastomosis. A 55-year-old nondiabetic female presented to us with complaints of gradual decreased vision and metamorphopsia in both her eyes of 3 months duration. Her best-corrected visual acuity (BCVA) was 20/120 OU. Right, eye showed a grayish white lesion in the perifoveal retina with subretinal hemorrhage [Figure 1]a. The right-angled venules and the telangiectatic capillaries were delineated in the fluorescein angiography (FFA) confirming the diagnosis of parafoveal telangiectasia [Figure 1]b and [Figure 2]b. The right eye angiography showed hyper-fluorescence of the perifoveal lesion with intense leak seen in late phases [Figure 1]b-d and optical coherence tomography (OCT) showed intraretinal cysts and thickened retinal pigment epithelium (RPE) Bruch's complex confirming the diagnosis of subretinal neovascular membrane (SNV) [Figure 3]a. Left eye OCT [Figure 4]a showed subfoveal disruption of the high-intensity RPE signal and thickening of the perifoveal retina. The patient received 3 doses of intravitreal injections of 1.25 mg of bevacizumab in 0.05 ml in her right eye repeated at an interval of every 4 weeks. She received a single dose of the same injection in her left eye [Figure 4]b.
Figure 1: Right eye: (a) Color fundus photo: Parafoveal telangiectasia type II (proliferative stage) with subretinal neovascular membrane (b) perifoveal lesion demonstrating blocked fluorescence corresponding to the hemorrhage and hyperfluorescence of the active subretinal neovascular membrane. Evidence of arteriovenous anastomosis overlying the subretinal neovascular membrane (black arrow) (c) midphase: Increased hyperfluorescence from the subretinal neovascular membrane (d) late stage fluorescein angiography: Intense leak from the subretinal neovascular membrane

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Figure 2: Left eye: (a) Fundus photo nonproliferative stage, crystalline deposits, vascular changes (b) less intense staining of deep retinal capillary plexus (black arrow) (c) capillary plexus showing leakage of dye (d) Intense hyperfluorescence from inner retinal capillary plexus

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Figure 3: (a) Optical coherence tomography right eye: Showing subretinal neovascular membrane with subretinal fluid, intraretinal cysts and thickened retinal pigment epithelium Bruchs' complex (b) optical coherence tomography right eye after avastin injection: Resolution of the subretinal fluid and intraretinal cysts

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Figure 4: (a) Optical coherence tomography left eye: Blunting of the foveal reflex, increase in the perifoveal retinal thickness, disruption of the high-intensity retinal pigment epithelium signal (b) optical coherence tomography left eye after injection avastin showing reduction in the retinal thickness

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  Case Report Top


A 55-year-old nondiabetic female presented to us with complaints of gradual decreased vision and metamorphopsia in both her eyes of 3 months duration. Her BCVA was 20/120 OU. Anterior segment OU was normal. Her fundus in the right eye showed a yellowish white lesion in the perifoveal retina with a rim of subretinal hemorrhage [Figure 1]a. Left eye showed telangiectatic capillaries in the perifoveal retina with refractile lesions [Figure 2]a. The diagnosis of parafoveal telangiectasia (PFT) was confirmed by FFA which demonstrated the right-angled venules and the telangiectatic capillaries [Figure 1]b and [Figure 2]b. The right eye angiography showed an incremental hyperfluorescence of the perifoveal lesion with intense leak seen in late phases suggestive of subretinal neovascular membrane [Figure 1]b-d. Left Eye angiography showing deep ectatic retinal capillary plexus with dye leak [Figure 2]c and [Figure 2]d Right, eye OCT showed pockets of subretinal fluid, intraretinal cysts, and thickened RPE Bruch's complex confirming the diagnosis of subretinal neovascular membrane [Figure 3]a. Left eye OCT showed subfoveal disruption of RPE Bruch's complex both eyes [Figure 4]a and thickening of the perifoveal retina.[1] The patient received 3 doses of intravitreal injections of 1.25 mg of bevacizumab in 0.05 ml in her right eye repeated at an interval of every 4 weeks. She received a single dose of the same injection in her left eye. The left eye was considered for treatment because of the poor visual acuity (20/120) at presentation, with evidence of a parafoveal leak of fluorescein dye as seen in the angiography and presence of intraretinal parafoveal edema as evident from the OCT.


  Discussion Top


Type II PFT is a bilateral retinal vascular disorder consisting of an incompetent, ectatic capillary bed, with or without irregular dilatation of the capillaries confined to the juxtafoveal area. Retino-retinal, retino-subretinal, and choroidal anastomosis have been earlier reported with proliferative stage of type II PFT.[2] OCT angio would be the ideal tool to give us more information on the vascular anastomotic features. The angiography of our patient [Figure 5] and [Figure 6] demonstrate these typical features. Patient's vision improved to20/80 in both her eyes with treatment.[1],[3] Angiography and OCT done at 8 weeks showed a regressed SNV [Figure 3]b.
Figure 5: Fluorescein angiography right eye: Retino-retinal anastomosis seen in the neovascular membrane between a feeding arteriole (red arrow) and draining venular branch (blue arrow). Retino-subretinal anastomosis (yellow arrow): Originating from a venule the course of the vessel is deeper as seen by the overlying vessels and suggests a subretinal vascular feeder network

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Figure 6: Fluorescein angiography left eye: Partial obliteration of the foveal avascular zone, wreath-like appearance of the ectatic deep retinal capillary plexus and microaneurysms (white arrow)

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Issa PC, Holz FG, Scholl HP. Findings in fluorescein angiography and optical coherence tomography after intravitreal bevacizumabin type 2 idiopathic macular telangiectasia. Ophthalmology 2007;114:1736-42.  Back to cited text no. 1
    
2.
Engelbert M, Yannuzzi LA. Idiopathic macular telangiectasia type 2: The progressive vasculopathy. Eur J Ophthalmol 2013;23:1-6.  Back to cited text no. 2
    
3.
Jorge R, Costa RA, Calucci D, Scott IU. Intravitreal bevacizumab (Avastin) associated with the regression of subretinal neovascularization in idiopathic juxtafoveolar retinal telangiectasis. Graefes Arch Clin Exp Ophthalmol 2007;245:1045-8.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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