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A rare case of idiopathic parafoveal telangiectasia associated with central serous chorioretinopathy

Thomas, Nicey Roy; Roy, Rupak; Saurabh, Kumar; Das, Kalpita

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Indian Journal of Ophthalmology: June 2017 - Volume 65 - Issue 6 - p 516-517
doi: 10.4103/ijo.IJO_167_17
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A 39-year-old female presented with gradual diminution of vision in her both eyes. She had been diagnosed with choroidal neovascularization (CNV) in the left eye in past and had received three anti-vascular endothelial growth factor (anti-VEGF) injections. Best-corrected visual acuity was 20/60 in both eyes. Anterior segment examination was unremarkable in both eyes. Fundus of the right eye showed subretinal hemorrhage, retinal pigment epithelium (RPE) atrophy, and right-angled venule at macula along with RPE alterations near the superior arcade [Fig. 1a]. Left eye showed RPE atrophy with pigment epithelial detachment (PED) [Fig. 1b]. Fluorescein angiography (FA) of the right eye showed parafoveal telangiectatic vessels with leakage characteristic of parafoveal telangiectasia (PFT) along with early hyperfluorescence with late leakage at the temporal margin of the fovea. Right eye also showed focal leak near superior arcade and multiple window defects suggestive of central serous chorioretinopathy (CSCR) [Fig 2a and b]. FA of the left eye revealed window defects, PED, and scarring [Fig. 2c]. Spectral domain optical coherence tomography (SDOCT) of the right eye showed subretinal hyperreflectivity with adjacent intraretinal edema suggestive of CNV [Fig. 3a]. Left eye showed a serous PED with scarring [Fig. 3b]. The patient was administered anti-VEGF in the right eye. SDOCT of the right eye after two injections showed resolution of the CNV.

Figure 1
Figure 1:
Color fundus photograph of the right eye showing subretinal hemorrhage with retinal pigment epithelium atrophy at the macula (arrow), a right-angled venule (white arrowhead) and retinal pigment epithelium alterations near the superior arcade (red arrowheads) (a). Color fundus photograph of the left eye showing retinal pigment epithelium atrophy (arrow) with pigment epithelial detachment (white arrowhead) (b)
Figure 2
Figure 2:
Fluorescein angiography of the right eye showing parafoveal telangiectatic vessels (arrow) with progressive leakage characteristic of parafoveal telangiectasia (a). Early hyperfluorescence with late leakage at the temporal margin of fovea suggestive of a choroidal neovascularization (arrow) and a focal leak above the superior arcade (red arrowhead) with multiple window defects (white arrowheads) suggestive of central serous chorioretinopathy (b). Fluorescein angiography of the left eye showing window defects (white arrowhead), pigment epithelial detachment (red arrowhead) and scarring (arrow) (c)
Figure 3
Figure 3:
Spectral domain optical coherence tomography of the right eye showing hyperreflectivity at the subretinal level (arrow) with intraretinal edema suggestive of choroidal neovascularization (a). Spectral domain optical coherence tomography of the left eye showing serous pigment epithelial detachment (white arrowhead) with scarring at the macula (arrow) (b)

Discussion

Natural course of PFT can be complicated by CNV which occurs due to intraretinal capillary proliferation and atrophy of the outer retina.[1] Our case had an unusual association of PFT with CSCR. CNV is also a known sequela of chronic CSCR.[2] Eyes with PFT may have concurrent vision-threatening retinal diseases. Such unusual associations have been reported only once till date.[3] Whether these associations are coincidental or could this indicate a broader, underlying pathology needs to be explored. Overlap in presentation and findings in such cases highlights the importance of multimodal imaging for the right diagnosis and treatment of PFT.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. Nowilaty SR, Al-Shamsi HN, Al-Khars W. Idiopathic juxtafoveolar retinal telangiectasis: A current review Middle East Afr J Ophthalmol. 2010;17:224–41
2. Bonini Filho MA, de Carlo TE, Ferrara D, Adhi M, Baumal CR, Witkin AJ, et al Association of choroidal neovascularization and central serous chorioretinopathy with optical coherence tomography angiography JAMA Ophthalmol. 2015;133:899–906
3. Atmani K, Querques G, Zourdani A, Benhamou N, Souied EH. Unusual presentations of type 2 idiopathic macular telangiectasia Ophthalmologica. 2013;230:126–30
Keywords:

Central serous chorioretinopathy; choroidal neovascularization; parafoveal telangiectasia

© 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow