Case of the Month | May 2021

Case of the Month
May 24, 2021

The Case

The patient was a 64-year-old woman who complained of a gradual loss of vision over several months. Her past medical history was remarkable for successfully treated cervical cancer. Her visual acuity was 20/50 without correction, pinhole 20/30, J1 OD and 20/70 without correction, pinhole 20/60, J2 OS. Examination with remarkable for early nuclear sclerotic cataracts in each eye and fundus findings (see images). What condition(s) were present? What treatment, if any, would you recommend?

This patient had idiopathic macular telangiectasia (IMT) in each eye and vitreo-macular traction (VMT) in the left eye. The fundus photographs revealed an abnormal whitening temporal to the fovea in each eye and hyperpigmentation temporal to the fovea in the left eye. As typically seen in IMT, there was inner cystoid edema from leaking juxtafoveal capillaries. The OCTA was also instructive in showing dilation and telangiectasia of these capillaries, particularly on the temporal side of the fovea in each eye. Of interest, there was a vertical reflective stalk of tissue inferotemporal to the fovea in the right eye without associated edema at that location. This likely reflected neovascularization without associated leakage. If there has been significant leakage, anti-VEGF treatment might have been warranted. The VMT in the left eye was likely contributing to the inner edema, and there were plans for close monitoring for consideration of vitrectomy and detachment of the posterior hyaloid. Also of interest in the left eye was the mid-retinal reflectivity that corresponded to pigment temporal to the fovea, which likely had the RPE as its source.

Case Photos

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This patient had idiopathic macular telangiectasia (IMT) in each eye and vitreo-macular traction (VMT) in the left eye. The fundus photographs revealed an abnormal whitening temporal to the fovea in each eye and hyperpigmentation temporal to the fovea in the left eye. As typically seen in IMT, there was inner cystoid edema from leaking juxtafoveal capillaries. The OCTA was also instructive in showing dilation and telangiectasia of these capillaries, particularly on the temporal side of the fovea in each eye. Of interest, there was a vertical reflective stalk of tissue inferotemporal to the fovea in the right eye without associated edema at that location. This likely reflected neovascularization without associated leakage. If there has been significant leakage, anti-VEGF treatment might have been warranted. The VMT in the left eye was likely contributing to the inner edema, and there were plans for close monitoring for consideration of vitrectomy and detachment of the posterior hyaloid. Also of interest in the left eye was the mid-retinal reflectivity that corresponded to pigment temporal to the fovea, which likely had the RPE as its source.

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