Fluorescein angiography of subretinal neovascular membrane in parafoveal telangiectasia type II demonstrating retino-retinal, retino-subretinal anastomosis

Parafoveal telangiectasia is also known as juxtafoveal retinal telangiectasis or idiopathic perifoveal telangiectasia. Clinical features include loss of the macular luteo pigment in the temporal fovea (gray reflex), microaneurysms, right-angled venules, crystalline deposits, and subretinal neovascular membrane. Our photo essay shows the angiographic documentation of the retino-retinal and subretinal anastomosis. A 55-year-old nondiabetic female presented to us with complaints of gradual decreased vision and metamorphopsia in both her eyes of 3 months duration. Her best-corrected visual acuity (BCVA) was 20/120 OU. Right, eye showed a grayish white lesion in the perifoveal retina with subretinal hemorrhage [Fig. 1a]. The right-angled venules and the telangiectatic capillaries were delineated in the fluorescein angiography (FFA) confirming the diagnosis of parafoveal telangiectasia [Fig. ​[Fig.1b1b and ​and2b].2b]. The right eye angiography showed hyper-fluorescence of the perifoveal lesion with intense leak seen in late phases [Fig. ​[Fig.1b1b–d] and optical coherence tomography (OCT) showed intraretinal cysts and thickened retinal pigment epithelium (RPE) Bruch's complex confirming the diagnosis of subretinal neovascular membrane (SNV) [Fig. 3a]. Left eye OCT [Fig. 4a] showed subfoveal disruption of the high-intensity RPE signal and thickening of the perifoveal retina. The patient received 3 doses of intravitreal injections of 1.25 mg of bevacizumab in 0.05 ml in her right eye repeated at an interval of every 4 weeks. She received a single dose of the same injection in her left eye [Fig. 4b].