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Ocular Outcomes and Interventions in Bilateral Retinal Telangiectasia
Cindy Zhao
Presenter:
Cindy S. Zhao, MD1, Diana V. Do, MD1, Chase Ludwig, MD1, Ehsan Rahimy, MD1,2, Prithvi Mruthyunjaya, MD, MHS1, Karen M. Wai, MD1
Authors:
Affiliation:
1. Byers Eye Institute at Stanford Health Care, Palo Alto, California
2. Palo Alto Medical Foundation, Palo Alto, California
Purpose: To compare the prevalence of ocular diseases and interventions between patients with bilateral retinal telangiectasia (RT), a proxy for macular telangiectasia type 2, and a matched cohort with presbyopia.
Methods: A retrospective cohort study using TriNetX, an aggregated electronic health records network. Patients at least 45 years old with an ICD-10 diagnosis of bilateral RT were compared to a control group with an ICD-10 diagnosis of presbyopia. In both cohorts, patients with cystoid or diabetic macular edema or exudative age-related macular degeneration were excluded. Propensity score matching (PSM) was done for age, sex, race, and ethnicity. Primary outcomes included the need for cataract surgery, intravitreal injection (IVI), pars plana vitrectomy (PPV), macular laser, retinopexy laser, or panretinal photocoagulation. Secondary outcomes included the rate of macular hole, retinal neovascularization, retinal detachment (RD), or vitreous hemorrhage.
Results: Prior to PSM, 2,030 patients had a diagnosis of bilateral RT and 883,807 patients had a diagnosis of presbyopia. Prior to PSM, RT patients (vs control +/- SD, respectively) were older (65.3 +/- 9.3 vs 61.5+/-10.1, p <0.001) and more likely to be White (79.1% vs 63.8%, p <0.001), female (62.6% vs 57.2%, p <0.001), and not Hispanic or Latino (80.5% vs 72.7%, p < 0.001). After PSM, no differences persisted. The mean follow-up time was 33.8 (SD 22.8) months for the bilateral RT cohort and 40.2 (SD 21.6) months for the presbyopia cohort. In order of decreasing relative odds, patients with bilateral RT patients (vs patients with presbyopia) had a higher rate of retinal neovascularization (8.5% vs 0.5%, OR 18.82, 95% CI: 9.92, 35.71, p < 0.001), macular hole (10.1% vs 1.0%, OR 11.29, 95% CI: 7.10, 17.95, p < 0.001), IVI (7.0% vs 0.7%, OR 10.75, 95% CI: 6.18, 18.68, p < 0.001), and PPV (1.0% vs 0.5%, OR 2.11, 95% CI: 0.99, 4.50, p =0.05). No significant differences (p>0.05) existed in rate of cataract surgery, macular or retinopexy laser, RD, or vitreous hemorrhage.
Conclusion: Patients with bilateral RT had significantly greater odds of IVI, PPV, and macular hole relative to a matched group with presbyopia. Macular telangiectasia type 2 is an uncommon and poorly understood neurodegenerative disease without proven treatments. Further effort is required to understand the pathophysiology and find effective therapies.
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