Anti-Vascular Endothelial Growth Factor Treatment Outcomes in Macular Telangiectasia: A Systematic Review.

Abstract

Purpose: To assess clinical outcomes of anti-vascular endothelial growth factor agents (anti-VEGF) for patients with Macular Telangiectasia (MacTel).

Methods: A systematic literature search on Ovid MEDLINE, Embase, and Cochrane Library was performed from inception to June 2024 for comparative studies on anti-VEGF agents in MacTel. The primary outcomes were the change in best-corrected visual acuity (BCVA). Secondary outcomes were central macular thickness (CMT), central choroidal thickness (CCT), and fluorescein angiography (FA) leakage.

Results: Ten studies on 377 eyes of 239 patients followed up over 23.4 ± 8.3 months were included. Mean (SD) BCVA changed from 0.42 (0.39) to 0.35 (0.18) over 23.4 (8.3) months of follow up in non-proliferative MacTel. Mean BCVA changed from 0.66 (0.43) to 0.52 (0.34) at final follow-up in eyes with choroidal neovascularization (CNV). Five studies reported improved visual acuity, one showed improved FA leakage without visual acuity benefit, and four found no functional benefit. In non-proliferative MacTel, four studies showed no functional improvement, two reported significant functional and morphological improvements, and one suggested potential benefits in improving BCVA. In proliferative MacTel, two studies demonstrated improvement in both anatomical and functional outcomes, while one indicated that anti-VEGF treatment might produce improved results. In non-proliferative MacTel, mean CMT changed from 201 (32) µm to 199 (29) µm. CMT in patients with CNV decreased from an initial of 328.23 (161.16) µm to 267.44 (118.56) µm at final follow up. CCT in proliferative MacTel eyes decreased from 272.37 (52.65) µm and 247.40 (48.80) µm on anti-VEGF therapy. Overall, FA leakage outcomes were improved on ranibizumab therapy. No study documented any significant adverse effects with treatment.

Conclusion: Anti-VEGF agents may be associated with favourable anatomical and functional outcomes, particularly in proliferative MacTel, however, future large-scale clinical trials are warranted.