Unveiling idiopathic macular telangiectasia: clinical applications of optical coherence tomography angiography

Purpose: Idiopathic macular telangiectasia type 2 (IMT2) is a bilateral acquired maculopathy, with a spectrum of clinical presentations associated with inner retinal telangiectatic vascular anomalies. Cases often are under-diagnosed or misdiagnosed. Current diagnostic modalities such as spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) are valuable to the understanding of the clinicopathology. More recently, optical coherence tomography angiography (OCTA), as an emerging noninvasive technology, has been shown to be particularly useful in the assessment and management of IMT2. Methods: Three clinical cases of IMT2 are discussed. Clinical presentation, fundus photography, FA, SD-OCT, and OCTA are presented. Each case illustrates variable presentation, staging, and associated findings related to IMT2. Results: Optical coherence tomography angiography provides additional value when paired with traditional multimodal imaging in the assessment and management of IMT2. Conclusions: These cases present an opportunity to demonstrate the features of the OCTA in the evaluation of vascular diseases such as IMT2. Additionally, these examples emphasize the critical importance of OCTA in the clinical diagnosis and management of IMT2.