Surgical Management of Foveal Telangiectatic Capillaries in Diabetic Macular Edema

We report a case of diabetic macular edema (DME) resistant to anti-VEGF therapy that was successfully treated with surgical intervention targeting foveal telangiectatic capillaries (TelCaps). A 61-year-old woman with a history of proliferative diabetic retinopathy and previous panretinal photocoagulation in both eyes developed refractory DME in the right eye, despite multiple intravitreal anti-VEGF injections. Indocyanine green angiography (ICGA) revealed two TelCaps located in the foveal and temporal regions. A 27-gauge pars plana vitrectomy was performed, including internal limiting membrane peeling around the TelCaps. The TelCaps were carefully grasped, elevated into the vitreous cavity, and treated by focal laser photocoagulation applied to their lateral surfaces using a curved laser probe, in order to minimize retinal damage. At 3 months postoperatively, the macular edema had resolved, best-corrected visual acuity improved from 20/100 to 20/33, and ICGA confirmed the absence of residual TelCaps. This case underscores the potential of surgical management as an alternative treatment for anti-VEGF-resistant TelCaps in patients with DME, particularly when the lesions are located in the fovea and are not amenable to conventional laser therapy.