to report the case of a patient with unilateral idiopathic macular telangiectasia ( imt ) associated with type 3 neovascularization . we describe a case of an 85-year - old woman who presented at our department with a gradual vision loss in her left eye ( le ) . fundus examination showed 2 small hemorrhages located nasally to the le fovea , as well as lipid exudates . spectral - domain optical coherence tomography ( sd - oct ) showed several microaneurysms within the inner retinal layers . no signs of imt or type 3 neovascularization were detected in the right eye . based on these findings the le was treated with intravitreal anti - vascular endothelial growth factor ( anti - vegf ) injections . twenty - four months later , sd - oct revealed regression of the exudative signs , and le bcva improved to 20/100 . we describe the case of an unusual association between older - onset imt and type 3 neovascularization , and subsequent regression by anti - vegf injections . we propose a new imt subtype called type 1c for this association . further research must be done in order to establish the pathophysiologic mechanism and likelihood of this association . in 1982 , gass and oyakawa   described idiopathic macular telangiectasia ( imt ) as a condition involving capillary ectasia and dilation in the juxtafoveal region . clinical presentation comprises decreased visual acuity , sometimes accompanied by metamorphopsia , as well as a central scotoma , as the disease slowly progresses . according to the classification by gass and blodi , there are 3 types of imt ( table 1 ) . type 1 ( imt-1 ) : unilateral macular telangiectasia with visible aneurysms , which occurs predominantly in males ; in this case , the cause of visual loss is mostly macular edema [ visible and exudative imt ( imt-1a ) ; visible , exudative and focal imt ( imt-1b ) ] . type 2 ( imt-2 ) : bilateral macular telangiectasia that occurs in men and women , with characteristic features on multimodal imaging ; subretinal or intraretinal neovascularization is frequently seen in this type [ occult and nonexudative imt ( imt-2a ) ; juvenile , occult and familial imt ( imt-2b ) ] . type 3 ( imt-3 ) : very rare , associated with vascular occlusions , occurring in the larger setting of a medical or neurological disease [ occlusive imt ( imt-3a ) ; occlusive imt associated with central nervous system vasculopathy ( imt-3b ) ] . moreover , in 2006 , yannuzzi et al .   merged the imt-1 subtypes into one group of aneurysmal telangiectasia , characterized by clearly visible aneurysms , and defined imt-2a as a group of perifoveal telangiectasia , leaving out imt-2b and imt-3 because of their rarity . in addition , they described the possible association of imt-2 with retino - retinal anastomosis and choroidal neovascularization . the therapeutic options for imt-1 consist of laser photocoagulation , which is the main treatment , as well as intravitreal injections ( ivts ) of steroids or anti - vascular endothelial growth factor ( anti - vegf ) agents . the case we report combines the characteristics of imt-1a with the intraretinal vascular complex typical of a type 3 neovascularization . an 85-year - old woman presented at our clinic complaining of gradual vision loss in her left eye ( le ) . her best - corrected visual acuity ( bcva ) was 20/80 in the right eye ( re ) and 20/200 in the le . fundus examination of the re was unremarkable , while for the le , it revealed 2 small hemorrhages located nasally to the fovea accompanied by lipid exudates inferiorly and superiorly ( fig . early - phase fluorescein angiography ( fa ; spectralis , sd - oct+hra , heidelberg engineering , germany ) was unremarkable in the re , while it demonstrated dilated capillaries within the le fovea , along with vascular tortuosity in the superior and nasal macula ( fig . early fa of the le also showed a zone of focal hyperfluorescence with a superotemporal right - angle dilated feeding vessel , deepening into the foveal avascular zone , evocative of a type 3 intraretinal neovascularization ( fig . spectral - domain optical coherence tomography ( sd - oct ; spectralis ) of the re showed an epiretinal membrane along with a discrete vitreomacular traction . sd - oct of the le revealed small , round , well - demarcated foveal lesions with hyperreflective edges in the inner retinal layers , corresponding to microaneurysms along with cystoid spaces . a hyperreflective lesion located in the outer retinal layers , temporal to the macula and adherent to the retinal pigment epithelium [ 6 , 7 ] , indicating the presence of type 3 intraretinal neovascularization , was also noted ( fig . indocyanine green angiography ( icga ; spectralis ) revealed a late hyperfluorescence and confirmed the presence of a type 3 neovascularization in the le ( fig . 2c ) . based on these findings , the patient was diagnosed with atypical imt-1 ( the average age at presentation of patients in this group is 37 years ) and coincident type 3 neovascularization . the patient was treated with a series of 3 monthly ivts of ranibizumab ( 0.5 mg/0.05 ml ) in the le followed by a prn regimen . at 6 months , after 3 ranibizumab ivts , bcva improved to 20/160 in the le . fa and icga showed absence of late - phase leakage from the lesion , and sd - oct revealed regression of the exudative signs ( fig . sd - oct revealed recurrence of exudative signs at 8 months , and thus , the patient received repeated ranibizumab ivts on a monthly basis up to month 14 ( 6 ivts ) . at month 16 , due to recurrence of exudative signs , the patient received repeated ranibizumab ivts on a monthly basis up to month 22 ( 6 ivts ) . at 24 months , after a total of 15 ivts , bcva improved to 20/100 in the le , and fa , icga and sd - oct showed regression of both cystoid macular edema and serous retinal detachment . we described the case of a patient diagnosed with atypical imt-1a associated with type 3 neovascularization . according to the classification by gass and blodi , the presence of a unilateral telangiectatic lesion accompanied by microaneurysms would suggest the diagnosis of imt-1a . nevertheless , the association of macular telangiectasia with a type 3 intraretinal neovascularization is a typical complication of imt-2 and is known to be a sign of exudative age - related macular degeneration [ 8 , 9 ] . to our knowledge , the shared characteristics between imt-1 and imt-2 have only been described once in a similar case in 2011 , by mezad - koursh et al . . given the unusual association observed , our cases , along with the case described by mezad - koursh et al . , are evocative of a new subtype of imt that we propose to call imt-1c , characterized by unilateral macular telangiectasia with visible aneurysms and macular edema , possibly complicated by type 3 neovascularization . the description of more cases of imt-1c is desirable in order to define this subtype of imt . the authors have no proprietary interest in the materials used in this study and received no financial or material support for the research and the work .