Navigated laser treatment with preliminary anti-VEGF therapy in macular telangiectasia type 1

Macular telangiectasia type 1 (MacTel1) is a rare condition characterized by multiple parafoveal microaneurysms, which leads to local nonperfusion, capillary ischemia, lipid and serous exudation which cause cystoid macular edema. Microaneurysms are detected by fluorescein angiography and optical coherence tomography-angiography. MacTel1 is relatively resistant to antiangiogenic therapy. Focal laser photocoagulation of microaneurysms is a pathogenetically substantiated treatment method. The use of navigation approach with topography-based planning allows increasing precision, safety and efficacy of laser effect. Clinical case. A 75-year-old patient with MacTel1, associated with a cystoid macular edema 702 µm. Treatment included intravitreal antiangiogenic therapy with consequent navigation targeted laser photocoagulation of microaneurysms. The best-corrected visual acuity and central retinal thickness were examined. After the combined treatment, best-corrected visual acuity increased from 0.3 to 0.9. OCT showed central retinal thickness reduction to 395 µm (∆307 µm). Fluorescein angiography showed decrease in the number and size of the microaneurysms, in the number of observed leakage points, in the intensity of the dye leakage. In the presented clinical case of MacTel1, the staged treatment approach including intravitreal antiangiogenic therapy with consequent navigation targeted laser photocoagulation of microaneurysms showed its effectiveness in reducing cystoid macular edema height and in improving visual functions.