Telangiectatic capillaries remodel over time in eyes with persistent diabetic macular edema

PURPOSE: To study telangiectatic capillaries (TelCaps) in the context of diabetic macular edema (DME) and the response to injection therapy. METHODS: A retrospective analysis of 25 eyes with center involving DME that had TelCaps diagnosed on infrared reflectance (IR) and optical coherence tomography (OCT) B-scans with at least one year of follow-up. The size of the TelCaps was assessed on OCT IR and B-scans. The main outcome measures were the change in visual acuity (VA), central subfield thickness (CST), OCT biomarkers of DME, and size and number of TelCaps. RESULTS: Compared to baseline, at 1 year and final follow-up (mean 44 months), the mean logMAR VA changed from 0.23 to 0.26 and 0.34, respectively (p = 0.296 and 0.139), and the mean CST changed from 325 μm to 348 μm and 355 μm, respectively (p = 0.172 and 0.098). 72% of the eyes had unchanged or worse VA and 64% had increased CST on final follow-up. The mean number of TelCaps per eye decreased from 1.36 at baseline to 1.12 at 1 year and 0.76 at the final follow-up (p = 0.04), with disappearance in 11 eyes (44%), and new TelCaps appearing in 3 eyes (12%). The mean size of the TelCaps was also significantly reduced at 1-year and final follow-up on both OCT IR images and B-scans. CONCLUSION: Visualized on OCT B-scans and IR, TelCaps are dynamic structures that undergo significant remodeling over time. Eyes with DME and TelCaps treated with injection therapy of anti-VEGF or steroids after at least one year exhibited persistent DME despite a decrease in number and size of TelCaps. TelCaps may serve as a potential biomarker for chronic DME.