Mac Tel

Mac Tel
SYMPTOMS Typically asymptomatic in the early stages of the disease but eventually may experience central vision loss, central scotomas, and metamorphopsia
SIGNS Mac Tel Type 1 (typically unilateral): Telangiectatic retinal capillaries, Cystoid macular edema, Intraretinal hemorrhages, Exudates, Cystoid macular edema with the majority of findings seen temporal to the fovea. There is typically no peripheral retina involvement
Mac Tel Type 2 (typically bilateral): Grayish discoloration of the area temporal to the fovea (earliest sign) that will eventually surround the fovea 360 degrees, Decrease in the amount of macula luteal pigment, Telangiectatic retinal capillaries, Dilated right-angled venules, Localized retinal thickening temporal to the fovea, Yellow intraretinal crystals, Yellow foveal lesion, Macular holes, RPE hyperplasia, Choroidal neovascular membranes with the majority of findings seen temporal to the fovea. There is typically no peripheral retina involvement and no signs of intraretinal hemorrhages and exudates
WORK-UP Full eye exam with dilated retinal exam, OCT analysis of the macula (Mac Tel Type 1: Presence of cystoid macular edema and exudates / Mac Tel Type 2: Cavitations that typically start in the inner nuclear layer and ellipsoid zone that eventually involve other areas of the inner and outer retina, ILM drape, Disruption or thinning of the ellipsoid zone, RPE proliferation with posterior shadowing, Choroidal neovascular membranes), OCT-Angiography (dilatation and alteration of foveal capillaries at the deep capillary vascular complex especially temporal to the fovea), Fluorescein Angiography, Indocyanine Green Angiography, Fundus Autofluorescence, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT Give take home Amsler grid in order to monitor for change
There is no available treatment for Mac Tel Type 1 and Mac Tel Type 2 and needs to be monitored
If there is cystoid macular edema and/or exudates which is associated with Mac Tel Type 1 or a choroidal neovascular membrane which is associated with Mac Tel Type 2, the patient should be referred to a retinal specialist (treatment typically involves intravitreal anti-VEGF injections)
FOLLOW-UP If monitoring Mac Tel, the patient should be seen back in 6 months
If macula is stable following treatment by retinal specialist, the patient should be seen back in 4-6 months
Mac Tel Type 2 can be associated with hypertension and diabetes: 1. Blood pressure evaluation 2. Fasting blood sugar 3. HbA1c
ETIOLOGY Telangiectatic alterations of the juxtafoveal capillary network secondary to Muller cell degeneration. Retinal telangiectasia are dilated retinal vessels that can be associated with aneurysmal dilatations, leakage, and exudates
DIFFERENTIAL DX Coats disease, Cone dystrophy, Solar maculopathy, Tamoxifen maculopathy
NOTES Mac Tel Type 2 is more common than Mac Tel Type 1
Mac Tel Type 1 is considered a variant of Coats disease
Mac Tel: OCT-Angiography demonstrating dilatation and alteration of capillaries temporal to the fovea