Long Term Result of Intravitreal Bevacizumab in a Patient Newly Transformed to Proliferative Macular Telangiectasia Type 2
A 47-year-old female was admitted to our clinic with a complaint of decreased vision in the right and left eye (OU) in December 2009. She was in excellent health. On baseline examination, monocular best corrected visual acuity (BCVA) was 20/25 in both eyes. Biomicroscopic anterior segment examination was normal, and intraocular pressure was within normal limits OU. Biomicroscopic fundus examination revealed macular hole like images OU. FA, showed a horse shoe shaped hyperfluorescence on the temporal fovea OU []. Optical coherence tomography (OCT) showed an internal limiting membrane (ILM) drape OU []. The central retinal thickness (CRT) was 198 microns and 210 microns, in the right and left eyes respectively. Based on the clinical and imaging findings the patient was diagnosed with MacTel type 2 and advised to present for examinations every 2 months. Four months later, the patient complained of decreased vision in the left eye (OS). On the examination, BCVA was 20/100 OS, and fundus examination revealed a grey reflex representing a SRN beneath the fovea. FA showed a subfoveal classic choroidal neovascularization (CNV) associated with leakage OU []. OCT showed a high reflective area located subfoveally, and associated with intraretinal and subretinal fluid collection, and the CRT was 318 microns OS []. The patient was diagnosed with proliferative MacTel type 2 OS, and underwent 3 consecutive monthly 1.25 mg IVB injections. After these injections, BCVA increased to 20/25, and both clinical and angiographic features showed significant improvement with minimal leakage on FA and absence of intra- or sub-retinal fluid on OCT examination. The CRT was 258 microns []. Follow-up examinations were scheduled monthly and treatment regimen of IVB injections as clinically required was planned. Retreatment criteria were determined as; loss of visual acuity of ≥1 line, and detection of any amount of intra- or subretinal fluid on OCT. At month 12, OCT showed subretinal fluid with a CRT of 259 microns OS. BCVA remained stable at 20/25 OS. The patient underwent another IVB injection OS. At month 24, the BCVA decreased to 20/63, and FA showed active leakage around the CNV OS. After the fifth IVB injection, BCVA improved to 20/40 OS. At month 29 as BCVA decreased to 20/126 and OCT showed subretinal fluid, a sixth IVB injection was administered. At month 30, visual acuity improved to 20/40, and OCT revealed a hyperreflective CNV scar located subfoveally, with a CRT of 198 microns OS []. No adverse events were detected due to IVB injections during follow up. The right eye remained stable with a visual acuity of 20/25 for 30 months, and did not show any signs of proliferative MacTel type 2.