Direct laser photocoagulation to the dilated right-angled vessel in the management of proliferative type 2 macular telangiectasia

Purpose: To report a case of proliferative Type 2 macular telangiectasia treated successfully with direct laser photocoagulation to the right-angled vessel. Methods: Descriptive case report. Case Description: A 61-year-old man, with no past medical history, was diagnosed and treated previously elsewhere for bilateral proliferative Type 2 macular telangiectasia. He complained of recent onset decrease in vision in his right eye for last 2 months. Right eye visual acuity was counting fingers at 3 m and left eye was 6/18. Fundus examination showed proliferative Type 2 macular telangiectasia in both eyes with active neovascular complex in the right eye. Direct thermal laser photocoagulation to the tips of the right-angled vessels with single-spot PASCAL Synthesis (Topcon Medical Laser System) at 532 nm wavelength was done. After laser, reduction in the hyporeflective space height was noted on optical coherence tomography. No additional intravitreal anti–vascular endothelial growth factor injections were required. At the last 6-months follow-up visit, visual acuity improved to 6/36, N18 in the right eye. Conclusion: Direct laser photocoagulation to the right-angled vessel can be considered as possible treatment option for proliferative Type 2 macular telangiectasia, especially in patients nonresponsive to anti–vascular endothelial growth factor therapy. However, long-term follow-ups are required to see whether it is possible to maintain the efficacy.