Título

MACULAR TELANGIECTASIA FOLLOWING BILATERAL ADNEXECTOMY - A CASE REPORT

Objetivo

To report a case of vision loss by Macular Telangiectasia in a patient after bilateral adnexectomy.

Relato do Caso

A 39-year-old female patient with a prior history of hemorrhagic ovarian cyst that was treated with bilateral adnexectomy presented with progressive vision loss that initiated 2 years after the surgery. At the first evaluation, complete ophthalmologic examination showed best corrected visual acuity (BCVA) of 20/40 in the right eye (OD) and 20/20 in the left eye (OS). Anterior segment biomicroscopy was unremarkable. Tonometry was normal in both eyes (OU). Fundoscopy evidenced subtle greyish loss of parafoveal retinal transparency extending up to one disc diameter from the foveola. FAF showed central foveal hyperautofluorescence (Figure 1). OCT showed hyporeflective subfoveal cyst in OD and loss of outer nuclear layer in OU (Figure 2). One year later, the patient complained of worsening visual in OD and the BCVA dropped to 20/80, with OCT showing a subtle foveal cyst enlargment.

Conclusão

Macular telangiectasia (MacTel) is a cronic neurodegenerative process involving Muller cells characterized by structural abnormalities of the deep capillaries around the fovea, leading to loss of outer nuclear layers and ellipsoid zone that can progress to cystic cavitation. Risk factors include hypertension, diabetes mellitus and dyslipidemia. The observation that first symptoms in patients with MacTel usually occur around the menopause lead to the hypothesis that sex steroids could play a role in the pathophysiology of the disease. Also, previous studies indicated neuroprotective properties of sex steroids in various models of neuronal injury. Although the etiology of MacTel currently remains unknown, the presented case suggest a role of sex steroids in the pathogenesis of MacTel.