Telangiectatic capillaries remodel over time in eyes with persistent diabetic macular edema

TL;DR

Telangiectatic capillaries in diabetic macular edema change over time and may not respond well to standard treatments.

Contribution

This study shows that TelCaps are dynamic structures that remodel over time and may serve as a biomarker for chronic DME.

Findings

TelCaps decreased in number and size over time despite persistent DME.

Eyes with TelCaps showed stable or worse visual acuity after injection therapy.

Infrared and OCT imaging effectively detect and track TelCaps.

Abstract

To study telangiectatic capillaries (TelCaps) in the context of diabetic macular edema (DME) and the response to injection therapy.

A retrospective analysis of 25 eyes with center involving DME that had TelCaps diagnosed on infrared reflectance (IR) and optical coherence tomography (OCT) B-scans with at least one year of follow-up. The size of the TelCaps was assessed on OCT IR and B-scans. The main outcome measures were the change in visual acuity (VA), central subfield thickness (CST), OCT biomarkers of DME, and size and number of TelCaps.

Compared to baseline, at 1 year and final follow-up (mean 44 months), the mean logMAR VA changed from 0.23 to 0.26 and 0.34, respectively (p = 0.296 and 0.139), and the mean CST changed from 325 μm to 348 μm and 355 μm, respectively (p = 0.172 and 0.098). 72% of the eyes had unchanged or worse VA and 64% had increased CST on final follow-up. The mean number of TelCaps per eye decreased from 1.36 at baseline to 1.12 at 1 year and 0.76 at the final follow-up (p = 0.04), with disappearance in 11 eyes (44%), and new TelCaps appearing in 3 eyes (12%). The mean size of the TelCaps was also significantly reduced at 1-year and final follow-up on both OCT IR images and B-scans.

Visualized on OCT B-scans and IR, TelCaps are dynamic structures that undergo significant remodeling over time. Eyes with DME and TelCaps treated with injection therapy of anti-VEGF or steroids after at least one year exhibited persistent DME despite a decrease in number and size of TelCaps. TelCaps may serve as a potential biomarker for chronic DME.

The gold-standard for Telangiectatic capillaries (TelCaps) detection is indocyanine green angiography, which is invasive and may not be readily available in all settings.Diabetic macular edema (DME) associated with TelCaps may respond poorly to injection therapy by anti-vascular endothelial factor and steroids.

The gold-standard for Telangiectatic capillaries (TelCaps) detection is indocyanine green angiography, which is invasive and may not be readily available in all settings.

Diabetic macular edema (DME) associated with TelCaps may respond poorly to injection therapy by anti-vascular endothelial factor and steroids.

Infrared reflectance imaging complemented by optical coherence tomography B-scans are effective in the detection and measurement of TelCaps, which appeared to be dynamic lesions that remodel over time.Eyes with DME and TelCaps with at least one year of follow-up ended up with persistent edema and stable or worse vision after injection therapy.

Infrared reflectance imaging complemented by optical coherence tomography B-scans are effective in the detection and measurement of TelCaps, which appeared to be dynamic lesions that remodel over time.

Eyes with DME and TelCaps with at least one year of follow-up ended up with persistent edema and stable or worse vision after injection therapy.

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