Macular Telangiectasia Type 2 MCQ — NEET PG Practice Question | NEETPGAI
Macular Telangiectasia Type 2
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eye Ophthalmology
A 55-year-old woman with type 2 diabetes presents with paracentral blur and reading difficulty. On dilated fundoscopy, both maculae show a faint greyish sheen and loss of transparency just temporal to the fovea (marked **A** in the diagram), with right-angled venules dipping into the fovea and tiny refractile crystalline deposits. Spectral-domain OCT reveals hyporeflective cavities in the inner and outer retina temporal to the fovea without retinal thickening, and disruption of the ellipsoid zone. Fluorescein angiography demonstrates dilated telangiectatic capillaries in the deep capillary plexus with late staining but no significant leakage. What is the most likely diagnosis?
A. Idiopathic macular telangiectasia type 2
B. Central retinal artery occlusion with collateral neovascularisation
C. Diabetic macular oedema with capillary occlusion
D. Age-related macular degeneration with reticular pseudodrusen
Explanation
Why Idiopathic macular telangiectasia type 2 is right
The greyish parafoveal sheen temporal to the fovea (marked A) in conjunction with the clinical triad of hyporeflective cavities in the inner and outer retina, disruption of the ellipsoid zone, and dilated telangiectatic capillaries in the deep capillary plexus on fluorescein angiography with late staining but no significant leakage is pathognomonic for idiopathic macular telangiectasia type 2 (MacTel type 2). This condition is characterized by selective involvement of the deep capillary plexus temporal to the fovea, presenting with the distinctive greyish sheen and loss of transparency. The absence of clinically significant macular oedema, microaneurysms outside the parafovea, and hard exudates distinguishes this from diabetic maculopathy despite the patient's diabetes history. According to AAO BCSC Section 12, MacTel type 2 is a distinct entity separate from diabetic retinopathy, defined by these specific structural and angiographic features.
Why each distractor is wrong
Diabetic macular oedema with capillary occlusion: While the patient has diabetes, the clinical presentation lacks the hallmark features of DME—namely, clinically significant retinal thickening, microaneurysms outside the parafovea, and hard exudates. The hyporeflective cavities and selective deep capillary plexus involvement are atypical for diabetic maculopathy.
Age-related macular degeneration with reticular pseudodrusen: AMD typically presents with drusen, retinal pigment epithelium changes, and choroidal neovascularisation in older patients. The specific pattern of deep capillary plexus telangiectasia, hyporeflective cavities, and ellipsoid zone disruption temporal to the fovea is not consistent with AMD.
Central retinal artery occlusion with collateral neovascularisation: CRAO presents acutely with sudden vision loss and retinal whitening. The chronic, slowly progressive nature of the greyish sheen, the selective deep capillary plexus involvement, and the absence of acute retinal ischaemia findings exclude this diagnosis.
High-YieldNEET PG
MacTel type 2 is defined by selective deep capillary plexus telangiectasia temporal to the fovea with hyporeflective cavities and ellipsoid zone disruption—a distinct entity separate from diabetic retinopathy despite potential diabetes coexistence.
AAO Retina/Vitreous BCSC, Section 12
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