Case Study - A case of retinal telangiectasia

Hard exudates alerted Mr John Jacob and Dr Zeeshan Ahmad to retinal telangiectasia.

A 62-year-old woman was referred after her optometrist noticed exudative retinopathy in her right eye. He also remarked that the patient had been complaining of reduced vision in the same eye.

The patient said that she felt her vision was deteriorating and that her optician had prescribed her reading spectacles. She had been diagnosed with hypertension recently and was taking appropriate treatment.

She had no notable previous ocular history, nor was there any family history of eye problems. She was well otherwise.

Visual acuity was 6/36 in the patient's right eye, with no improvement with pinhole, and 6/9 in her left eye.

On examination, the anterior segment was relatively quiet with the iris, cornea and lens unremarkable bilaterally.

However, on examining the posterior pole of the right eye, a region of leaky vessels was noted juxtafoveally. On closer inspection, a telangiectatic pattern of vessels was noted. Around these vessels was a circinate ring of hard exudates.

The left eye was normal.

Laser treatment

A diagnosis of retinal telangiectasia was made. Fluorescein angiography showed a branch retinal vein occlusion with secondary macular oedema.

Macular laser treatment to the right eye was planned, and an improvement in her vision was anticipated with resolution of macular oedema following focal laser treatment.

Hard exudates arise as a result of the formation of lipid and lipoprotein deposits, and are a sign of abnormal vascular permeability from optic disc, retinal or subretinal vessels.

Within the retina a hard exudate is seen as a yellowish, well-circumscribed accumulation, deep to the retinal vessels in the outer plexiform nerve fibre layer. They occur in two types of retinal distribution: either as a circinate pattern (a complete or partial circle separated from the leaking vessel by a clear zone), or as a macular star, in which case the lipid accumulates in the fibre layer of Henle surrounding the macula.

Vascular leakage

Lipid accumulation does not always follow vascular leakage. Lipid normally gathers at the interface between normal and abnormal retina, as in age-related macular degeneration.

Macular stars may result from a leaking vascular focus either adjacent to the macula, in the peripheral retina or in the underlying retinal pigment epithelium. They may also result from optic disc leakage when they tend to be more prominent on the nasal side of the macula; these are particularly common in the resolving phases of the optic disc infarction. Further lipid deposits in a circinate pattern or macular star will progress to form a plaque of exudate.

- Mr John Jacob is consultant ophthalmic surgeon, and Dr Zeeshan Ahman is house officer in ophthalmology, Royal Devon and Exeter Hospital, Devon

REFERENCES

- Spalton DJ, Hutchings RA, Hunter PA. Atlas of Clinical Ophthalmology, 3rd ed. Elsevier Mosby (London, 2005).

- Kanski JJ. Clinical Ophthalmology - A Systematic Approach, 5th ed. Butterworth-Heinemann (London, 2003).

- Gudnadottir GS, Magnusson KP, Stefansson E, et al. The time pattern of bilateral exudative age-related macular degeneration. Acta Ophthalmol Scand (2005); 83(3): 333-6.

- Hartnett ME, Weiter JJ, Staurenghi G, et al. Deep retinal vascular anomalous complexes in advanced age-related macular degeneration. Ophthalmology 1996; 103(12): 2,042-53.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

External wall of GP surgery with wording 'medical centre'

‘Utterly toxic’: GPs speak out over abuse and physical attacks on practice teams

GPs have condemned a rise in verbal and physical attacks on practice staff - warning...

Artist's image of a spiked virus

Javid warns of 'substantial risk' from new COVID-19 variant

The highly mutated COVID-19 variant B.1.1.529 'may pose a significant risk to public...

Desk with lettering 'LMC conference'

LMCs reject 'outdated' GMS contract and demand move to item of service payments

LMCs have voted to scrap the 'outdated and inadequate' GMS contract and to replace...

GPs at an LMC conference waving green voting cards in the air

LMCs demand ringfence on enhanced services cash and clear GP representation in ICSs

LMCs have called for a ringfence on enhanced services funding, along with a guarantee...

Close up of hands typing on a computer

Practices should not be required to provide online consultations, say LMCs

Online consultations should no longer be a part of the GMS contract and targets for...

Sign outside BMA House

More than half of GP practices prepared to pull out of PCNs, BMA ballot shows

More than half of GP practices in England are prepared to opt out of the PCN DES...