Sir,

In reply to Takayama et al,1 and to further support findings of Gamulescu et al,2 we wish to report a case of type 1 idiopathic macular telangiectasia (IMT) successfully treated with intravitreal bevazinumab.

Case report

A 76-year-old man with hypertension and ischaemic heart disease came with painless, progressive blurring of vision in the right eye for 2 months. His best-corrected visual acuity was 6/60. There was macular oedema with underlying microaneurysms and hard exudates. Cystoid macular oedema was seen on optical coherence tomography (OCT). Fundus fluorescent angiography (FFA) showed multiple areas of telangiectasia temporal to the fovea with dye leakage at the mid- and late-phase angiograms (Figures 1a and b).

Figure 1
figure 1

(a) Late-phase fundus fluorescent angiography (FFA) of the right eye at presentation. (b) OCT of the right eye reveals retinal thickening and multiple cystic spaces in the inner retinal layers.

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The patient was diagnosed with chronic cystoid macular oedema secondary to type 1 IMT and was given one dose of intravitreal bevacizumab (1.25 mg per 0.05 ml) to his right eye. Visual acuity improved to 6/36 at one month and a second dose of intravitreal bevacizumab was given. Vision further improved and stabilised at 6/12 after the third dose of intravitreal bevacizumab 1 month later. OCT showed resolution of macular oedema and FFA showed cessation of vascular leakage (Figures 2a and b). No further treatment was given and no recurrence was noted at 1 year.

Figure 2
figure 2

(a) Late-phase FFA of the right eye at 12 months follow-up. (b) OCT of the right eye shows resolution of inner retinal cysts.

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Comment

There are many documented improvement of visual and anatomical function for the treatment of type 2 IMT with bevacizumab and ranibizumab.3, 4, 5 Little information exists in the treatment of type 1 IMT with anti-VEGF and its number and dose of injections. Recently, Takayama et al reported five patients injected with two to three doses of bevacizumab and followed over 12 months. They found that both visual acuity and macular oedema did not improve with the injections except for one case.1 Our case concurs with Gamalescu et al2 who also reported stability of visual acuity, cessation of leakage seen on FFA, and sustained improvement of macular oedema seen on OCT over a period of 12 months after the injection of intravitreal bevazinumab. This is a second of such reported case.

This case holds promise to the treatment of type 1 IMT with intravitreal bevazinumab. What remains now is the need to have larger case series to confirm the efficacy and dosage of treatment as hitherto, all reported series have been small.