The Use of SWEPT SOURCE OCT Angio in Diagnosis and Staging of Type 2
Macular Telangictasia (MacTel 2)
Al Mamoori Fawwaz*
Medical Retina Department, Eye Specialty Hospital Amman, Jordan
- *Corresponding Author:
- Fawwaz Falih Al-Mamoori
Medical Retina Department
Eye Specialty Hospital, Amman, 11821, Jordan
Email: [email protected]
Received Date: December 13, 2016; Accepted Date: January 10, 2017; Published Date: January 28, 2017
Citation: Fawwaz AM (2017) The Use of SWEPT SOURCE OCT Angio in Diagnosis and Staging of Type 2 Macular Telangictasia (MacTel 2). J
Clin Exp Ophthalmol 8:634. doi: 10.4172/2155-9570.1000634
Copyright: © 2017 Fawwaz AM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Diagnosis and staging of macular telangiectasia type 2 (MacTel2) using Swept Source optical coherence tomography angiography
MacTel2, Angiography, Swept Source optical coherence
Macular telangiectasia type 2 has also been termed idiopathic
perifoveal telangiectasia or idiopathic juxtafoveal telangiectasis type 2
[1-3]. It is now referred to as MacTel type 2, and it is a bilateral
perifoveal vasculopathy which originates in the deep retinal capillary
plexus in the temporal juxtafoveal region . As it progresses, it
involves the superficial retinal capillary plexus, and continues to
progress anteriorly, posteriorly, and circumferentially. This is called the
non-proliferative stage of the disease [5-9]. Mactel type 2 becomes
proliferative when the vasogenic process extends under the retina,
forming detachment and a retinal–retinal anastomosis. This form of
the disease may eventually lead to disciform scarring.
In the early stages of the disease, fluorescein angiography (FA)
imaging shows abnormal hyperfluorescence and leakage from the
temporal, juxtafoveal capillary plexus, as the disease progresses, the
hyperfluorescence and leakage spreads circumferentially around the
fovea . While FA provides a definitive diagnosis of MacTel2, it also
involves the intravenous injection of a dye that can result in adverse
effects such as nausea or vomiting, and rarely fluorescein can elicit an
anaphylactic response [10-12]. Autofluorescence (AF) imaging is also
useful in diagnosing MacTel2 , Due to the depletion of luteal
pigment in the temporal juxtafoveal retina, a relative increase in AF is
observed in this region [14-16]. As the disease progresses, luteal
pigment is lost circumferentially around the fovea and an increase in
the relative hyperfluorescence is observed. In the later stages of the
disease, atrophy of the RPE is observed, resulting in decreased AF
within the central macula.
Optical coherence tomography (OCT), a noninvasive imaging
modality, has revealed structural abnormalities in the inner retina such
as retinal cavitation with draping of the internal limiting membrane
and abnormalities in the outer retina such as disruption of the
photoreceptor inner segment/outer segment/ellipsoid (IS/OS/E) region
that were not previously appreciated by FA or AF imaging [17-25].
OCT imaging has improved the early detection of MacTel2 by
identifying these early subtle changes in retinal anatomy, and OCT has
proven to be useful for following these alterations in macular anatomy
as the disease progresses to foveal atrophy, the formation of intraretinal pigment plaques, and subretinal neovascularization. With the
development of spectraldomain OCT (SDOCT) instruments with
increased scanning speeds and highspeed sweptsource OCT (SSOCT)
instruments, OCT microangiography imaging has emerged as a
noninvasive strategy to visualize the retina and choroidal
microvasculature without the use of an exogenous intravenous dye
injection, [26-37] and identifying distinct characteristics of the
capillary networks located within different layers of the retina and
Aim and Objectives
Diagnosis and staging of macular telangiectasia type 2 (MacTel2)
using Swept Source optical coherence tomography Angiography.
Patient and Method
We retrospectively review a 60 year old patient with bilateral
MacTel2 evaluated using a swept source OCT (SSOCT). The patient
underwent a comprehensive ocular examination and imaging tests as
part of the evaluation of her condition. The imaging tests included
color fundus imaging (Topcon, Tokyo, Japan), digital fundus AF
imaging, FA and Swept Source OCT with OCT Angio (TRITON
The patient had no any other retinal pathology such as diabetic
retinopathy or pathologic myopia and not previously treated with
photodynamic therapy (PDT), thermal laser, intravitreal injections, or
any retinal surgery. Information about previous medical conditions
and ocular treatments was obtained by reviewing the medical charts.
(SS-OCT A) detected abnormal microvasculature in all MacTel2
eyes, predominantly in the middle retinal layer. These vessels
correlated well with the FA alterations. The abnormal temporal,
juxtafoveal microvasculature in MacTel2 became apparent as the
disease progressed and in later stages tended to extend
circumferentially, with anastomotic vessels temporally.
In our Case, the Right Eye was in Early, Nonproliferative MacTel2,
Best corrected visual acuity (BCVA) in her left eye was 20/30. The
horizontal Bscan with the retinal flow in different layers represented by colors shows the dilated vessels in the deep retinal capillary plexus
found in the middle retinal layer, most pronounced in the region
temporal to the fovea as observed in green (Figure 1A and B).With intact IS-OS Junction (Figure 3), Fluorescein angiography shows
telangiectatic abnormalities with mild hyperfluorescence and leakage
in the temporal juxtafoveal region (Figure 2).
Figure 1: Horizontal Bscan with the retinal flow in different layers represented by colors.
Figure 2: Fluorescein angiography showing telangiectatic abnormalities with mild hyperfluorescence and leakage in the temporal juxtafoveal
Figure 3: IS-OS Junction.
The left eye was in Proliferative MacTel 2, best corrected visual
acuity (BCVA) in her left eye was 20/50, and The Bscan shows
cavitation in the outer retina and disruption of the IS/OS/E boundary
in the temporal juxtafoveal region. The Bscan representing the
microvascular flow (Figure 4A and B) details the presence of abnormal
microvasculature (green and blue corresponding to an area with retinal vascular anastomoses. Disruption of the microvasculature extends into
the outer retina where the IS/OS/E is disrupted. Microvascular
abnormalities, such as a distorted juxtafoveal capillary plexus with
prominent anastomoses, FA imaging demonstrates hyperfluorescence
in the temporal juxtafoveal region in the earliest stage associated with
late leakage (Figure 5).
Figure 4: Bscan representing the microvascular flow.
Figure 5: FA imaging demonstrates hyperfluorescence in the temporal juxtafoveal region in the earliest stage associated with late leakage.
We used the SS-OCT angio technique to investigate eyes with
MacTel2 using a TRITON SSOC. To extract the blood flow
information and visualize the microvasculature of the central macula,
the central macular microvasculature was visualized better than with FA imaging. In addition, the better visualization of the juxtafoveal
microvasculature with SS-OCT Angio may also be due, in part, to the
absence of leakage on OCT Angio imaging, and it is this leakage that
could obscure the normal vasculature seen on routine FA imaging. By using this ability to extract and visualize these retinal layers in MacTel2
and other diseases, SS-OCT Angio imaging may help facilitate the
early diagnosis of disease and provide a better understanding of disease
progression and the efficacy of treatments and to differentiate MacTel2
from other diseases affecting the retinal microvasculature associated
with fluorescein angiographic leakage, such as neovascular agerelated
macular degeneration, diabetic macular edema, vein occlusions, and
cystoid macular edema from differing conditions.
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