Combination Therapy with Photodynamic Therapy and Intravitreal Bevacizumab in Idiopathic Macular Telangiectasia Type I

In Geun Kim; Ji Eun Lee; Jung Min Park

doi:10.3341/jkos.2016.57.12.1897

Journal List > J Korean Ophthalmol Soc > v.57(12) > 1010478

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Kim, Lee, and Park: Combination Therapy with Photodynamic Therapy and Intravitreal Bevacizumab in Idiopathic Macular Telangiectasia Type I

Original Article

J Korean Ophthalmol Soc 2016;57(12):1897-1902.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1897

Combination Therapy with Photodynamic Therapy and Intravitreal Bevacizumab in Idiopathic Macular Telangiectasia Type I

In Geun Kim, MD¹, Ji Eun Lee, MD, PhD², Jung Min Park, MD, PhD¹

¹Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

²Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Jung Min Park, MD, PhD Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 48972, Korea Tel: 82-51-461-2469, Fax: 82-51-462-3534 E-mail: pjm1438@hanmail.net

Received 11 August 2016 Revised 4 October 2016 Accepted 23 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the clinical manifestations of combination therapy with photodynamic therapy (PDT) and intravitreal bevacizumab in idiopathic macular telangiectasia type I patients.

Methods

The present study included 7 patients who visited our clinic from May 2008 to February 2011 complaining of decreasing visual acuity and diagnosed as idiopathic macular telangiectasia type I including visible aneurysms at juxtafoveal area and telangiectatic vessels leakage based on fluorescein angiography. Additionally, all patients were treated with combination therapy with PDT and intravitreal bevacizumab.

Results

Visual acuity improved from 0.48 ± 0.14 (log MAR) to 0.18 ± 0.17 (log MAR) after the combination therapy, however, there was no change in intraocular pressure between before (17.9 ± 3.1) and after (16.8 ± 2.3) therapy. After combination therapy, fluorescein angiography showed decreased leakage of telangiectatic vessels and optical coherence tomography showed only minimal intraretinal edema. Central subfield macular thickness decreased from 301.9 ± 50.7 μ m to 193.6 ± 58.8 μ m after the combination therapy.

Conclusions

Combination therapy with intravitreal bevacizumab injection and PDT in patients with idiopathic macular telangiectasia type Ⅰ can result in a rapid decrease of macular edema, which can lead to rapid visual recovery.

Keywords: Idiopathic macular telangiectasia type Ⅰ, Intravitreal bevacizumab, Photodynamic therapy

References

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Figure 1.

Fluorescein angiography and opti-cal coherence tomography before treatment. Fluorescein angiography of telangiectatic vessels at the early phase (A) and leakage at the late phase (B). (C) Optical coherence tomography of intraretinal edema before combination treatment.

Figure 2.

Fluorescein angiography and optical coherence tomography after treatment. Fluorescein angiography of a regression of the telangiectatic vessels (A) and a decreased leakage of telangiectatic vessels at the late phase after combination therapy(B). (C) Optical coherence tomography of minimal intraretinal edema and restored foveal depression after treatment.

Table 1.

Clinical characteristics of the patient at presentation

Case	Sex/Age B	BCVA (log MAR)	IOP (mm Hg) Ce	ntral subfield macular thickness (	(μ m) Follow-up (months)
1	M/70	1.3	14.2	311	12
2	M/64	0.5	21.0	368	7
3	F/51	0.3	13.7	239	14
4	M/54	0.2	17.9	323	12
5	F/67	0.8	18.2	341	7
6	M/65	0.4	16.0	340	23
7	F/49	0.3	21.5	244	7
Mean		0.48	17.93	301.88	11.13
SD		0.14	3.08	50.69	5.59

BCVA = best corrected visual acuity; log MAR = logarithm of minimal angle resolution; IOP = intraocular pressure; SD = standard deviation.

Table 2.

Clinical outcomes after combined therapy for idiopathic macular telangiectasia type I

	BCVA (log MAR)	p-value	CSMT (μ m)	p-value
Baseline	0.48 ± 0.14		301.9 ± 50.7
1 month	0.30 ± 0.20	0.06	227.9 ± 53.6	0.02
2 months	0.30 ± 0.21	0.06	211.1 ± 61.3	0.01
6 months	0.18 ± 0.17	0.02	193.6 ± 58.8	0.01

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; log MAR = logarithm of minimal angle resolution; CSMT= central subfield macular thickness.

Table 3.

Change of best corrected visual acuity

Visual acuity (log MAR)	Initial number (%)	Final number (%)
VA ≤ 0.3	3 (42.8)	7 (100)
0.3 < VA ≤ 1.0	3 (42.8)	0 (0)
1.0 < VA	1 (14.4)	0 (0)
Total	7 (100)	7 (100)

Values are presented as n (%). log MAR = logarithm of minimal angle resolution; VA = visual acuity.

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