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Multicolour Imaging Signatures to Diagnose Concurrent Macular Telangiectasia Type 2 and Macular Branch Retinal Vein Occlusion

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Case Reports

Multicolour Imaging Signatures to Diagnose Concurrent Macular Telangiectasia Type 2 and Macular Branch Retinal Vein Occlusion

Ike Schouten et al. GMS Ophthalmol Cases.

Abstract

Concurrent macular telangiectasia type 2 (MacTel) and branch retinal vein occlusion (BRVO) have not been described before and can pose a diagnostic dilemma. The current report highlights the role of multicolour (MC) imaging and blue reflectance (BR) imaging in diagnosing this multi-pathology. A 60-year-old male presented with diminution of vision in the right eye. BR imaging showed parafoveal hyperreflectance, characteristic of MacTel, and hyperreflective parafoveal retinal vessels indicating vascular changes in RVO. MC imaging, particularly the BR component is a promising tool to aide in the diagnosis of concurrent MacTel and BRVO, guiding treatment decisions and prognosticating treatment outcomes.

Keywords: blue reflectance imaging; branch retinal vein occlusion; macular telangiectasia type II; multicolour imaging.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Color fundus photo and spectral domain optical coherence tomography of the right and the left eye.
Colour fundus photo showing macular edema with hard exudates in the right eye (a), microaneurysms, RPE changes and a dull foveal reflex in the left eye (b). Horizontal spectral domain optical coherence tomography scan through the fovea revealed cystic changes with thickening of the fovea, hyperreflective dots corresponding to the hard exudates, and attenuation of the ellipsoid zone in the central and temporal parafoveal area of the right eye (c). In the left eye, spectral domain optical coherence tomography showed a central hyporeflective space in the outer retina with loss of the ellipsoid zone (d).
Figure 2
Figure 2. Multicolour composite images (MC) and blue reflectance images.
The MC image showed greenish hue inferior to the fovea (between arrows) and yellow dots corresponding to the hard exudates (a). In the left eye MC composite image, the microaneurysms were clearly seen as dark red dots (arrow) (b). In the blue reflectance image, increased parafoveal reflectance was seen in both eyes (closed arrows) (c,d). Additionally, in the right eye it showed a clear distinction between hyperreflective vessels in the inferior parafovea and the hyporeflective appearance of other vessels in the blue reflectance image image (open arrows).
Figure 3
Figure 3. Fundus Fluorescein angiography early (a,b) and late phase (c,d).
In the right eye, telangiectatic vessels in the temporal and inferior parafovea with few microaneurysms are seen in the early phase (a). In the left eye, microaneurysms in the parafoveal region are seen in the early phase (b). Late phase images show diffuse hyperfluorescence in the right eye (c) and mild staining of the temporal parafovea in the left eye (d).
Figure 4
Figure 4. Horizontal spectral domain optical coherence tomography image through the fovea of the right eye one month after Ranibizumab therapy shows reduction of the central foveal thickness and complete resolution of the cystoid changes. Few hyperreflective dots corresponding to hard exudates are still seen and central loss of ellipsoid zone is seen centrally (between open arrows).

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