Timing of ocular examination and retinal imaging for the diagnosis of type 2 macular telangiectasia (MacTel)

Abstract

Purpose To report a case demonstrating the relevance of ocular examination and retinal imaging timing in type 2 macular telangiectasia (MacTel) Case description A 55-year-old-female complained of blurring of vision in the left eye for the last 6 months. Corrected visual acuity was 20/20, N6 and 20/30, N8 in the right and left eye respectively. Anterior segment examination was normal in both eyes. Her both eyes’ fundus was seen initially by the general ophthalmologist and was subsequently referred to the retinal specialist. Results Dilated fundus examination of the right eye appeared normal while the left eye showed no specific retinal pathology except for a dull foveal reflex. Retinal imaging with optical coherence tomography and confocal blue reflectance (CBR) imaging were not conclusive of any specific clinical diagnosis. A fluorescein angiography and repeat CBR imaging was done on the following day which now clearly showed the features of type 2 MacTel. Conclusion Specific clinical and imaging features in type 2 MacTel are observed better in the absence of light exposure. Retinal imaging with CBR should not be performed immediately after dilated retinal examination in a suspected case of type 2 MacTel.