An Unusual Presentation of Parafoveal Telangiectasia

Parafoveal telangiectasia (PFT) is an idiopathic, bilateral, asymmetric, neurodegenerative condition, primarily affecting Muller cells.[1–3] This case presents an unusual presentation of subretinal fluid (SRF) in nonproliferative PFT. A 36-year-old man presented with defective vision in both eyes (OU) for 3 years. He was diagnosed with cystoid macular edema/central serous chorioretinopathy (CSCR) in OU elsewhere and treated with multiple antivascular endothelial growth factor (anti-VEGF) injections with suboptimal visual outcomes. BCVA was 6/18 in right eye and 6/9 in left eye. OU fundus examination revealed parafoveal loss of retinal transparency, RPE alterations and dilated right-angulated venules, suggestive of PFT [Figure 1a and b]. Swept-source optical coherence tomography (SSOCT) showed subretinal fluid (mimicking CSCR), intraretinal cysts, and ellipsoid zone loss [Figure 1c and d]; SSOCT angiography showed no subretinal neovascularization (SRNV) [Figure 1e and f] but parafoveal telangiectatic capillaries in deep vascular plexus [Figure 1g and h]. Blood investigations were unremarkable, ruling out systemic conditions causing SRF. Since there was no SRNV, anti-VEGF injection was deferred, and the patient was closely observed. SRF in the absence of SRNV (nonproliferative PFT) is uncommon.[3] The source of SRF could be ectatic capillaries or an early intraretinal neovascular complex.[3] Treatment options remain limited, and role of anti-VEGF therapy is unclear due to the absence of SRNV.Figure 1: Multicolor (a and b) showing a loss of retinal transparency in the parafoveal area, pigment plaques and blunted dilated venules (yellow arrows) in the both eyes; along with crystalline deposits in the right eye (white arrows). SSOCT line scan images demonstrating serous neurosensory detachment, intraretinal cystic spaces and loss of ellipsoid zone (c and d). SSOCTA-ORCC (outer retina-choriocapillaris) slab showing no evidence of SRNV (e and f). SSOCTA shows telangiectatic capillaries in deep plexus (g and h)Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.