Unilateral Retinal Telangiectasia with Peripheral Vascular Sheathing: A Case Report

Unilateral Retinal Telangiectasia with Peripheral Vascular Sheathing: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Unilateral Retinal Telangiectasia with Peripheral Vascular Sheathing: A Case Report Chien Xue Low, Shelina Oli Mohamed, Mimiwati Zahari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4564212/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Sep, 2024 Read the published version in BMC Ophthalmology → Version 1 posted 4 You are reading this latest preprint version Abstract Background Idiopathic retinal telangiectasia refers to ectatic changes in retinal blood vessels without identifiable causes. This includes a range of diseases such as Coats’ disease, Leber’s miliary aneurysms, and macular telangiectasia. Visual acuity can be severely affected when there is severe exudation or if the macula is involved. However, retinal telangiectasia can also be a sequelae to a primary ocular or systemic disorder, also known as ‘’Coats’-like reaction”. As a result, clinical presentations can overlap, making diagnosis a challenge. We present a case of unilateral retinal telangiectasia in a young adult male with atypical features of peripheral vascular sheathing and distal non-perfusion in the absence of clinically visible exudation and discuss its diagnostic challenges. Methods Case report. Results A 25-year-old male presented with painless blurring of vision in the right eye for two months. Best-corrected Snellen visual acuity was 3/60 in the affected eye, with relative afferent pupillary defect observed, and 6/9 contralaterally. Anterior segment examination was unremarkable. Right eye fundoscopy showed aneurysmal telangiectasia at the macula, 360 degrees perivascular sheathing and telangiectasia of peripheral retinal vessels. There was no exudation, neovascularization, tractional membranes, vitritis, retinitis and choroiditis. Left eye fundus was unremarkable. Optical coherence tomograph of the macula revealed disorganization and thinning of the inner retinal layers with minimal intraretinal fluid. Fundus fluorescein angiography showed leakage from the aneurysms, extensive peripheral capillary fallout and enlarged foveolar avascular zone. Blood investigations ruled out metabolic, infective, hematological and autoimmune causes. Carotid Doppler showed no stenosis and CT angiography of the brain did not show any vascular abnormalities. In view that no causes was identified, a diagnosis of idiopathic peripheral telangiectasia, possibly stage 1 Coats’ disease, was made. Treatment consisted of FFA-guided laser photocoagulation to the areas of non-perfusion. Intavitreal anti-vascular endothelial growth factor was not done in view of poor visual prognosis. The condition and visual acuity remained stable during 18 months of follow-up. Conclusion This case highlights the overlapping spectrum of retinal telangiectasia and its diagnostic challenges. Although stage 1 Coats’ disease could be a possibility, some features were atypical for this diagnosis. An inflammatory vasculitis with a secondary “Coats-like reaction” is postulated, but the exact etiology is still unknown. retina telangiectasia exudation Coats’ disease Coats’-like reaction vascular sheathing case report Figures Figure 1 Figure 2 Figure 3 Introduction Idiopathic retinal telangiectasia (IRT) refers to aneurysmal or ectatic changes in retinal blood vessels without identifiable secondary causes. 1 – 3 It is usually associated with exudation and can cause exudative retinal detachment in severe form. 1 – 3 IRT comprises a wide spectrum of disease including Coats’ disease, which represents the most severe entity, to less severe entities such as Leber’s miliary aneuryms, macular telangiectasia (MACTEL), and simple peripheral retinal telangiectasia. 1 – 3 Typically, IRT affects males, with more severe disease presenting early during the first decade, and vice versa. 4 – 5 Diagnosis can be difficult as there are overlapping features among the various diseases. 1 – 3 Adding to the challenge, retinal telangiectasia can also occur as a sequelae to primary ocular or systemic diseases, also known as a “Coats-like reaction”. 3 , 6 – 7 Despite various proposed classification systems for IRT, consistency remains lacking. 2–3,8−9 Here, we report an unusual case of IRT in a 25-year-old male exhibiting unilateral retinal telagiectasia accompanied by subtle macular edema, extensive peripheral vascular sheathing and distal non-perfusion in the absence of clinically visible exudation. Case Report A 25-year-old healthy Malay male presented with painless blurring of vision in the right eye for two months which he noticed after a trivial blunt injury by card-box. He was a regular smoker with a 4-pack year history. He was born full-term with no significant past ocular or medical history, no history of receiving radiotherapy, and his family history was non-contributory. Relative afferent pupillary defect was observed in the right eye. The best-corrected Snellen visual acuity (VA) was 3/60 and 6/6 in the right and left eye respectively. There was no manifest strabismus. Anterior segment examination was unremarkable and intraocular pressures were 14 mmHg bilaterally. Fundoscopy of the right eye revealed multiple aneurysmal dilatations at the macula with loss of foveolar reflex (Fig. 1 A). There was 360-degree perivascular sheathing and telangiectatic changes involving the equatorial to peripheral retinal vessels (Fig. 1 B). However, there was absence of venous dilatation and tortuosity, hemorrhages, exudation, vitritis, retinitis or choroiditis. The optic disc was pink with a cup-to-disc ratio of 0.4. Fundoscopy of the left eye was unremarkable. Systemic examination including the central nervous system was unremarkable. Right eye spectral-domain optical coherence tomography (OCT) of the macula revealed disorganization of inner retinal layers, significant thinning of the inner and outer nuclear layers, minimal intraretinal fluid, and an epiretinal membrane. However, there was no retinal thickening and the external limiting membrane, ellipsoid and retinal pigment epithelium (RPE) layers remained largely unaffected (Fig. 2 A). Central subfield thickness was 266µm. OCT angiography (OCTA) revealed aneurysms and loss of juxtafoveal capillary network in the superficial, intermediate, and deep vascular complex layers (Fig. 2 B-C). Right eye fundus autofluorescence (FA) showed an increased area of hypoautofluorescence at the macula with patchy hyperautofluorescence within. Fundus fluorescein angiography (FFA) showed no delay in the arm-to-retina or arterio-venous (AV) transit time. Early phase revealed aneurysmal dilatations of varying sizes predominantly at the posterior pole and to a lesser extent at the periphery (Fig. 3 A). There was loss of juxtafoveal capillary network and an enlarged foveolar avascular zone (FAZ). The peripheral vessels were telangiectatic with large areas of capillary non-perfusion distally involving all clock hours. In the late phase, there was leakage from the aneurysms but no leakage from the sheathed vessels or neovascularization was noted (Fig. 3 B). There was no staining of the optic disc. The left eye FA and FFA was unremarkable. The blood pressure was within normal limits. Laboratory investigations done included full blood count, peripheral blood film, coagulation profile, fasting lipid profile, fasting blood glucose, and complement 3 and 4, which were within normal limits. Rheumatoid factor, anti-nuclear antibodies, anti-neutrophil cytoplasmic antibody, anti-beta-2 glycoprotein 1, anti-cardiolipin, lupus anticoagulant, rapid plasma reagin, tuberculin skin test, and Tuberculosis-Quantiferon assay were negative. Imaging tests, including chest X-ray, echocardiography and carotid Doppler ultrasonography, were unremarkable. Computed tomography angiography and venography of the brain showed no evidence of cerebral infarct, aneurysms, arteriovenous malformations, or thrombosis. A guarded visual prognosis was explained in view of the FFA and OCT macula findings. Prophylactic laser retinal photocoagulation of the peripheral avascular zones was done as patient was from outstation and could not commit to regular follow-ups. He was offered intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, but he opted for conservative management in view of guarded prognosis. His condition remained stable throughout a follow-up period of 18 months. Discussion The atypical presentation of this case posed a challenge for diagnosis. The ocular findings of unilateral aneurysmal dilatations distributed mainly at the posterior pole with features of macular edema and ischemia, together with peripheral vascular sheathing and telangiectasia did not fulfil a specific diagnosis. Hence, we will discuss a few possible differential diagnoses. A clear history together with thorough examination and investigation supported an idiopathic cause of unilateral telangiectasia. Adult-onset Coats’ disease was considered, as it typically affects young males and is unilateral. 1 , 6 The absence of exudation in this case suggests the possibility of a stage 1 disease according to Shields’ staging system where there is presence of telangiectasia only. 8 Several studies have shown that Coats’ disease that presents in adulthood is milder in severity with less extent of telangiectasia, less foveal involvement and better in visual outcomes. 4–5,10−11 However, we did not find this correlation in our case. The poor VA was attributed to the macular findings. The presence of multiple aneurysmal telangiectasia at the macula is rare in Coats’ disease but is characteristic of Leber’s miliary aneurysms or MACTEL type 1, both of which are considered milder variants of Coats’ disease. 7 , 12 However, this diagnosis still falls short with the absence of exudation and presence of peripheral vascular sheathing and telangiectasia. It is noteworthy to mention that such peripheral vascular abnormalities have been reported in an isolated case report of Leber’s miliary aneurysms with peripheral vascular sheathing and leakage on FFA which responded to intravitreal steroids. 13 This in combination with OCT findings of macular edema and disorganization of inner retinal layers suggests an underlying ischemic process. Hence, the possibility of retinal occlusive vasculitis with a secondary “Coats-like reaction” was considered as well. A previous retinal vein occlusion was given a strong consideration in this case. However, the duration of symptoms of only two months and the absence of retinal hemorrhages, collateral vessels at the disc, venous dilatation and tortuosity made this a less likely possibility. Furthermore, the arterio-venous transit time was not increased on FFA. Other inflammatory conditions like tuberculosis, Eales’ disease, syphilis, and Behcet’s disease were excluded due to the lack of signs of inflammation in the anterior chamber and posterior segment inflammation such as vitritis, choroiditis and retinitis. In addition, investigation results were also negative. Idiopathic retinal vasculitis-aneurysms-neuroretinitis (IRVAN) syndrome was ruled out as the aneurysmal dilatations are usually larger and are mainly located at arterial bifurcations. Furthermore, there was no exudation or neuroretinitis-like picture. Sickle cell retinopathy and other haematological conditions such as polycythemia and lymphoproliferative disorders were ruled out from blood investigations. Familial exudative vitreoretinopathy and retinopathy of prematurity were excluded as history was non-suggestive and there was no neovascularization, exudation or tractional membranes. Atypical retinitis pigmentosa was excluded too as capillary occlusion is usually not typically seen. We initiated FFA-guided laser retinal photocoagulation to the large areas of capillary non-perfusion despite the absence of neovascularization due to logistic reasons. As there was no exudation, cryotherapy was not indicated. Intravitreal anti-VEGF has been increasingly used in Coats’ disease as studies have found higher aqueous VEGF levels in affected eyes. 11 Although evidence is limited to a number of case reports and small case series, anti-VEGF therapy have been shown to induce regression of abnormal vessels, macular edema and exudation with better visual outcome. 2 , 6 However, our patient opted for conservative management in view of the guarded prognosis explained namely the ischemic features noted at the macula such as disorganization and thinning of inner retinal layers and FAZ enlargement. This case highlights the overlapping spectrum of retinal telangiectasia and its diagnostic challenges. Although stage 1 Coats’ disease could be a possibility, some features are atypical for this diagnosis. An inflammatory vasculitis with a secondary “Coats-like reaction” is postulated, but the exact etiology is still unknown. Abbreviations BCVA best-corrected visual acuity CT computed tomography EZ ellipsoid zone FA fundus autofluorescence FAZ foveolar avascular zone FFA fundus fluorescein angiography IRT idiopathic retinal telangiectasia MACTEL macular telangiectasia OCT optical coherence tomography OCTA optical coherence tomography angiography RPE retinal pigment epithelium VA visual acuity VEGF vascular endothelial growth factor Declarations Ethcis approval and consent to participate This study was approved by the Medical Research and Ethics Committee (MREC) of the Ministry of Health (MOH), Malaysia. Consent for publication Written consent to publish was obtained from the patient. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding No funding was obtained for this study. Authors’ contributions LCX acquired the patient data, wrote the manuscript and prepared figures 1-3. SOM and MZ interpreted the patient data and revised the manuscript. All authors reviewed the manuscript. Acknowledgments Not applicable. References Perez MA, Shechtnam DL, Gurwood A. The Continuum of Primary Retinal Telangiectasia. Optometry 2011;82:158-65. Gwecki M. Idiopathic Peripheral Retinal Telangiectasia in Adults: A Case Series and Literature Review. Journal of Clinical Medicine 2021;10,1767. https://doi.org/10.3390/jcm10081767. Accessed 17 May 2024. Cahill M, O’Keefe M, Acheson R, et al.Classification of the Spectrum of Coats’ Disease as Subtypes of Idiopathic Retinal Telangiectasis with Exudation. Acta Ophthalmologica Scandinavica 2001;79:596-602. Smithen LM, Brown GC, Brucker AJ, et al. Coats’ Disease Diagnosed in Adulthood. Ophthalmology 2005;112(6):1072-78. Lai CH, Kuo HK, Wu PC, et al. Manifestation of Coats’ Disease by Age in Taiwan. Clinical and Experimental Ophthalmology 2007;35:361-65. Sen M, Shields CL, Honavar SG, et al. Coats; Disease: An Overview of Classification, Management and Outcomes. Indian Journal of Ophthalmology 2019;67(6):763-71. Shields JA, Shields CL, Honavar SG, et al. Clinical Variations and Complications of Coats’ Disease in 150 Cases: The 2000 Sanford Gifford Memorial Lecture. American Journal of Ophthalmology 2001;131(5):561-70. Shields JA, Shields CL, Honavar SG, et al. Classification and Management of Coats’ Disease: The 2000 Proctor Lecture. American Journal of Ophthalmology 2001;131(5):572-83. Yanuzzi LA, Bardal AMC, Freund KB, et al. Idiopathic Macular Telangiectasia. Arch Ophthalmology 2006;124:450-60. Daruich A, Matet A, Munier FL. Younger Age at Presentation in Children with Coats’ Disease is Associated with More Advanced Stage and Worse Visual Prognosis: A Retrospective Study. Retina, The Journal of Retinal and Vitreous Diseases 2017;0(0):1-8. Shields CL, Udyaver S, Dalvin LA, et al. Visual Acuity Outcomes in Coats’ Disease by Classification Stage in 160 Patients. British Journal of Ophthalmology 2019; doi:10.1136/bjophthalmol-2019-314363. Yanuzzi LA, Bardal AMC, Freund KB, et al. Idiopathic Macular Telangiectasia. Arch Ophthalmology 2006;124:450-60. Lee A, Baek J, Ra H. A Case of Leber’s Miliary Aneurysms with Diffuse Peripheral Retinal Vascular Sheathing. Indian Journal of Ophthalmology 2018;66(10):1496-98. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Sep, 2024 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 14 Jun, 2024 Editor assigned by journal 14 Jun, 2024 Submission checks completed at journal 14 Jun, 2024 First submitted to journal 11 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4564212","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":314419121,"identity":"f40c03c3-4573-4203-b4cd-8abc671233bd","order_by":0,"name":"Chien Xue Low","email":"","orcid":"","institution":"UM Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya","correspondingAuthor":false,"prefix":"","firstName":"Chien","middleName":"Xue","lastName":"Low","suffix":""},{"id":314419122,"identity":"188bfac3-6b11-46f8-9212-90d417e70f92","order_by":1,"name":"Shelina Oli Mohamed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACCQbGAwkMEnL8IE5CAXFaGIBabIwlG0BaDIjVwsCQlmhwAMQjRov87OYDBx7uOJxgfH514ocHBgzy/GIH8GsxuHMs4UDimcN5ZjfebpYAOsxw5uwEAlokcgwOJLYdLja7cXYDSEuCwW0CWuRn5H8AaUncPOPs5h9EaWG4kcMA1JKWuIG/dxtxthjcSAM5zMZY4gbvNosEAwnCfpGfkfzw4c82YFT2n91880eFjTy/NCGHwYEEWKUEscpBgP8AKapHwSgYBaNgJAEAIghMAcsnyCMAAAAASUVORK5CYII=","orcid":"","institution":"Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA","correspondingAuthor":true,"prefix":"","firstName":"Shelina","middleName":"Oli","lastName":"Mohamed","suffix":""},{"id":314419123,"identity":"951fc74b-18b2-4c8e-943d-56edbee3ef51","order_by":2,"name":"Mimiwati Zahari","email":"","orcid":"","institution":"UM Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya","correspondingAuthor":false,"prefix":"","firstName":"Mimiwati","middleName":"","lastName":"Zahari","suffix":""}],"badges":[],"createdAt":"2024-06-11 12:46:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4564212/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4564212/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-024-03668-3","type":"published","date":"2024-09-27T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60185193,"identity":"467fb508-e1f0-44fe-a0fa-a605c06b4eaa","added_by":"auto","created_at":"2024-07-12 18:40:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1526770,"visible":true,"origin":"","legend":"\u003cp\u003eFundoscopy of the right eye. A) Multiple aneurysmal dilatations were observed at the macula with loss of foveolar reflex. B) Extensive perivascular sheathing and telangiectatic changes involving the equatorial andperipheral retinal vessels in all quadrants. No exudation and neovascularization was seen.\u003c/p\u003e","description":"","filename":"Fig1tif.png","url":"https://assets-eu.researchsquare.com/files/rs-4564212/v1/249764bd3778b77d6ec14702.png"},{"id":60185190,"identity":"88c59b85-67c0-44a7-b760-4199a7e8b79b","added_by":"auto","created_at":"2024-07-12 18:40:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":716231,"visible":true,"origin":"","legend":"\u003cp\u003eOCT and OCTA of the right eye macula. A) OCT revealed disorganization of inner retinal layers, thinning of the inner and outer nuclear layers, and minimal intraretinal fluid. The ellipsoid and RPE layers appeared intact. B-C) OCTA indicated presence of aneurysms and loss of juxtafoveal capillary network in the superficial and deep vascular complex layer, respectively.\u003c/p\u003e","description":"","filename":"Fig2TIF.png","url":"https://assets-eu.researchsquare.com/files/rs-4564212/v1/9fd3fd7e6ad6d43ccfd565f6.png"},{"id":60186166,"identity":"c6756d73-47d9-4326-a215-4f00d7c4adea","added_by":"auto","created_at":"2024-07-12 18:48:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":617175,"visible":true,"origin":"","legend":"\u003cp\u003eMontage FFA images of the right eye. A) Early phase showed multiple hyperfluorescent aneurysmal telangiectasia distributed in the posterior pole and periphery. The FAZ was enlarged, and there were extensive distal capillary fallout. B) Late phase demonstrated leakage from the aneurysmal telangiectasia.\u003c/p\u003e","description":"","filename":"Fig3tif.png","url":"https://assets-eu.researchsquare.com/files/rs-4564212/v1/17a3f7a18343214db79988a5.png"},{"id":65627135,"identity":"613fc7a7-240f-4641-b0a3-1b2e65937407","added_by":"auto","created_at":"2024-09-30 16:12:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3524004,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4564212/v1/ad243ce7-5754-4abc-a8b4-06a90addeae6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unilateral Retinal Telangiectasia with Peripheral Vascular Sheathing: A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIdiopathic retinal telangiectasia (IRT) refers to aneurysmal or ectatic changes in retinal blood vessels without identifiable secondary causes.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e It is usually associated with exudation and can cause exudative retinal detachment in severe form.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e IRT comprises a wide spectrum of disease including Coats\u0026rsquo; disease, which represents the most severe entity, to less severe entities such as Leber\u0026rsquo;s miliary aneuryms, macular telangiectasia (MACTEL), and simple peripheral retinal telangiectasia.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Typically, IRT affects males, with more severe disease presenting early during the first decade, and vice versa.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Diagnosis can be difficult as there are overlapping features among the various diseases.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Adding to the challenge, retinal telangiectasia can also occur as a sequelae to primary ocular or systemic diseases, also known as a \u0026ldquo;Coats-like reaction\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Despite various proposed classification systems for IRT, consistency remains lacking.\u003csup\u003e2\u0026ndash;3,8\u0026minus;9\u003c/sup\u003e Here, we report an unusual case of IRT in a 25-year-old male exhibiting unilateral retinal telagiectasia accompanied by subtle macular edema, extensive peripheral vascular sheathing and distal non-perfusion in the absence of clinically visible exudation.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 25-year-old healthy Malay male presented with painless blurring of vision in the right eye for two months which he noticed after a trivial blunt injury by card-box. He was a regular smoker with a 4-pack year history. He was born full-term with no significant past ocular or medical history, no history of receiving radiotherapy, and his family history was non-contributory. Relative afferent pupillary defect was observed in the right eye. The best-corrected Snellen visual acuity (VA) was 3/60 and 6/6 in the right and left eye respectively. There was no manifest strabismus. Anterior segment examination was unremarkable and intraocular pressures were 14 mmHg bilaterally. Fundoscopy of the right eye revealed multiple aneurysmal dilatations at the macula with loss of foveolar reflex (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). There was 360-degree perivascular sheathing and telangiectatic changes involving the equatorial to peripheral retinal vessels (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). However, there was absence of venous dilatation and tortuosity, hemorrhages, exudation, vitritis, retinitis or choroiditis. The optic disc was pink with a cup-to-disc ratio of 0.4. Fundoscopy of the left eye was unremarkable. Systemic examination including the central nervous system was unremarkable.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRight eye spectral-domain optical coherence tomography (OCT) of the macula revealed disorganization of inner retinal layers, significant thinning of the inner and outer nuclear layers, minimal intraretinal fluid, and an epiretinal membrane. However, there was no retinal thickening and the external limiting membrane, ellipsoid and retinal pigment epithelium (RPE) layers remained largely unaffected (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Central subfield thickness was 266\u0026micro;m. OCT angiography (OCTA) revealed aneurysms and loss of juxtafoveal capillary network in the superficial, intermediate, and deep vascular complex layers (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB-C).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRight eye fundus autofluorescence (FA) showed an increased area of hypoautofluorescence at the macula with patchy hyperautofluorescence within. Fundus fluorescein angiography (FFA) showed no delay in the arm-to-retina or arterio-venous (AV) transit time. Early phase revealed aneurysmal dilatations of varying sizes predominantly at the posterior pole and to a lesser extent at the periphery (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). There was loss of juxtafoveal capillary network and an enlarged foveolar avascular zone (FAZ). The peripheral vessels were telangiectatic with large areas of capillary non-perfusion distally involving all clock hours. In the late phase, there was leakage from the aneurysms but no leakage from the sheathed vessels or neovascularization was noted (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). There was no staining of the optic disc. The left eye FA and FFA was unremarkable.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe blood pressure was within normal limits. Laboratory investigations done included full blood count, peripheral blood film, coagulation profile, fasting lipid profile, fasting blood glucose, and complement 3 and 4, which were within normal limits. Rheumatoid factor, anti-nuclear antibodies, anti-neutrophil cytoplasmic antibody, anti-beta-2 glycoprotein 1, anti-cardiolipin, lupus anticoagulant, rapid plasma reagin, tuberculin skin test, and Tuberculosis-Quantiferon assay were negative. Imaging tests, including chest X-ray, echocardiography and carotid Doppler ultrasonography, were unremarkable. Computed tomography angiography and venography of the brain showed no evidence of cerebral infarct, aneurysms, arteriovenous malformations, or thrombosis. A guarded visual prognosis was explained in view of the FFA and OCT macula findings. Prophylactic laser retinal photocoagulation of the peripheral avascular zones was done as patient was from outstation and could not commit to regular follow-ups. He was offered intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, but he opted for conservative management in view of guarded prognosis. His condition remained stable throughout a follow-up period of 18 months.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe atypical presentation of this case posed a challenge for diagnosis. The ocular findings of unilateral aneurysmal dilatations distributed mainly at the posterior pole with features of macular edema and ischemia, together with peripheral vascular sheathing and telangiectasia did not fulfil a specific diagnosis. Hence, we will discuss a few possible differential diagnoses.\u003c/p\u003e \u003cp\u003eA clear history together with thorough examination and investigation supported an idiopathic cause of unilateral telangiectasia. Adult-onset Coats\u0026rsquo; disease was considered, as it typically affects young males and is unilateral.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The absence of exudation in this case suggests the possibility of a stage 1 disease according to Shields\u0026rsquo; staging system where there is presence of telangiectasia only.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Several studies have shown that Coats\u0026rsquo; disease that presents in adulthood is milder in severity with less extent of telangiectasia, less foveal involvement and better in visual outcomes.\u003csup\u003e4\u0026ndash;5,10\u0026minus;11\u003c/sup\u003e However, we did not find this correlation in our case. The poor VA was attributed to the macular findings. The presence of multiple aneurysmal telangiectasia at the macula is rare in Coats\u0026rsquo; disease but is characteristic of Leber\u0026rsquo;s miliary aneurysms or MACTEL type 1, both of which are considered milder variants of Coats\u0026rsquo; disease.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, this diagnosis still falls short with the absence of exudation and presence of peripheral vascular sheathing and telangiectasia. It is noteworthy to mention that such peripheral vascular abnormalities have been reported in an isolated case report of Leber\u0026rsquo;s miliary aneurysms with peripheral vascular sheathing and leakage on FFA which responded to intravitreal steroids.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e This in combination with OCT findings of macular edema and disorganization of inner retinal layers suggests an underlying ischemic process. Hence, the possibility of retinal occlusive vasculitis with a secondary \u0026ldquo;Coats-like reaction\u0026rdquo; was considered as well. A previous retinal vein occlusion was given a strong consideration in this case. However, the duration of symptoms of only two months and the absence of retinal hemorrhages, collateral vessels at the disc, venous dilatation and tortuosity made this a less likely possibility. Furthermore, the arterio-venous transit time was not increased on FFA. Other inflammatory conditions like tuberculosis, Eales\u0026rsquo; disease, syphilis, and Behcet\u0026rsquo;s disease were excluded due to the lack of signs of inflammation in the anterior chamber and posterior segment inflammation such as vitritis, choroiditis and retinitis. In addition, investigation results were also negative. Idiopathic retinal vasculitis-aneurysms-neuroretinitis (IRVAN) syndrome was ruled out as the aneurysmal dilatations are usually larger and are mainly located at arterial bifurcations. Furthermore, there was no exudation or neuroretinitis-like picture. Sickle cell retinopathy and other haematological conditions such as polycythemia and lymphoproliferative disorders were ruled out from blood investigations. Familial exudative vitreoretinopathy and retinopathy of prematurity were excluded as history was non-suggestive and there was no neovascularization, exudation or tractional membranes. Atypical retinitis pigmentosa was excluded too as capillary occlusion is usually not typically seen.\u003c/p\u003e \u003cp\u003eWe initiated FFA-guided laser retinal photocoagulation to the large areas of capillary non-perfusion despite the absence of neovascularization due to logistic reasons. As there was no exudation, cryotherapy was not indicated. Intravitreal anti-VEGF has been increasingly used in Coats\u0026rsquo; disease as studies have found higher aqueous VEGF levels in affected eyes.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Although evidence is limited to a number of case reports and small case series, anti-VEGF therapy have been shown to induce regression of abnormal vessels, macular edema and exudation with better visual outcome.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e However, our patient opted for conservative management in view of the guarded prognosis explained namely the ischemic features noted at the macula such as disorganization and thinning of inner retinal layers and FAZ enlargement.\u003c/p\u003e \u003cp\u003eThis case highlights the overlapping spectrum of retinal telangiectasia and its diagnostic challenges. Although stage 1 Coats\u0026rsquo; disease could be a possibility, some features are atypical for this diagnosis. An inflammatory vasculitis with a secondary \u0026ldquo;Coats-like reaction\u0026rdquo; is postulated, but the exact etiology is still unknown.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBCVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebest-corrected visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEZ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eellipsoid zone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003efundus autofluorescence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFAZ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003efoveolar avascular zone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003efundus fluorescein angiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eidiopathic retinal telangiectasia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMACTEL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emacular telangiectasia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eoptical coherence tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOCTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eoptical coherence tomography angiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRPE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eretinal pigment epithelium\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evisual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVEGF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evascular endothelial growth factor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthcis approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Research and Ethics Committee (MREC) of the Ministry of Health (MOH), Malaysia.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent to publish was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors’ contributions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eLCX \u0026nbsp;acquired the patient data, wrote the manuscript and prepared figures 1-3. SOM and MZ interpreted the patient data and revised the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgments\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePerez MA, Shechtnam DL, Gurwood A. The Continuum of Primary Retinal Telangiectasia. Optometry 2011;82:158-65.\u003c/li\u003e\n\u003cli\u003eGwecki M. Idiopathic Peripheral Retinal Telangiectasia in Adults: A Case Series and Literature Review. Journal of Clinical Medicine 2021;10,1767. https://doi.org/10.3390/jcm10081767. Accessed 17 May 2024.\u003c/li\u003e\n\u003cli\u003eCahill M, O\u0026rsquo;Keefe M, Acheson R, et al.Classification of the Spectrum of Coats\u0026rsquo; Disease as Subtypes of Idiopathic Retinal Telangiectasis with Exudation. Acta Ophthalmologica Scandinavica 2001;79:596-602.\u003c/li\u003e\n\u003cli\u003eSmithen LM, Brown GC, Brucker AJ, et al. Coats\u0026rsquo; Disease Diagnosed in Adulthood. Ophthalmology 2005;112(6):1072-78.\u003c/li\u003e\n\u003cli\u003eLai CH, Kuo HK, Wu PC, et al. Manifestation of Coats\u0026rsquo; Disease by Age in Taiwan. Clinical and Experimental Ophthalmology 2007;35:361-65.\u003c/li\u003e\n\u003cli\u003eSen M, Shields CL, Honavar SG, et al. Coats; Disease: An Overview of Classification, Management and Outcomes. Indian Journal of Ophthalmology 2019;67(6):763-71.\u003c/li\u003e\n\u003cli\u003eShields JA, Shields CL, Honavar SG, et al. Clinical Variations and Complications of Coats\u0026rsquo; Disease in 150 Cases: The 2000 Sanford Gifford Memorial Lecture. American Journal of Ophthalmology 2001;131(5):561-70.\u003c/li\u003e\n\u003cli\u003eShields JA, Shields CL, Honavar SG, et al. Classification and Management of Coats\u0026rsquo; Disease: The 2000 Proctor Lecture. American Journal of Ophthalmology 2001;131(5):572-83.\u003c/li\u003e\n\u003cli\u003eYanuzzi LA, Bardal AMC, Freund KB, et al. Idiopathic Macular Telangiectasia. Arch Ophthalmology 2006;124:450-60.\u003c/li\u003e\n\u003cli\u003eDaruich A, Matet A, Munier FL. Younger Age at Presentation in Children with Coats\u0026rsquo; Disease is Associated with More Advanced Stage and Worse Visual Prognosis: A Retrospective Study. Retina, The Journal of Retinal and Vitreous Diseases 2017;0(0):1-8.\u003c/li\u003e\n\u003cli\u003eShields CL, Udyaver S, Dalvin LA, et al. Visual Acuity Outcomes in Coats\u0026rsquo; Disease by Classification Stage in 160 Patients. British Journal of Ophthalmology 2019; doi:10.1136/bjophthalmol-2019-314363.\u003c/li\u003e\n\u003cli\u003eYanuzzi LA, Bardal AMC, Freund KB, et al. Idiopathic Macular Telangiectasia. Arch Ophthalmology 2006;124:450-60.\u003c/li\u003e\n\u003cli\u003eLee A, Baek J, Ra H. A Case of Leber\u0026rsquo;s Miliary Aneurysms with Diffuse Peripheral Retinal Vascular Sheathing. Indian Journal of Ophthalmology 2018;66(10):1496-98.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"retina, telangiectasia, exudation, Coats’ disease, Coats’-like reaction, vascular sheathing, case report","lastPublishedDoi":"10.21203/rs.3.rs-4564212/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4564212/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIdiopathic retinal telangiectasia refers to ectatic changes in retinal blood vessels without identifiable causes. This includes a range of diseases such as Coats’ disease, Leber’s miliary aneurysms, and macular telangiectasia. Visual acuity can be severely affected when there is severe exudation or if the macula is involved. However, retinal telangiectasia can also be a sequelae to a primary ocular or systemic disorder, also known as ‘’Coats’-like reaction”. As a result, clinical presentations can overlap, making diagnosis a challenge. We present a case of unilateral retinal telangiectasia in a young adult male with atypical features of peripheral vascular sheathing and distal non-perfusion in the absence of clinically visible exudation and discuss its diagnostic challenges.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eCase report.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA 25-year-old male presented with painless blurring of vision in the right eye for two months.\u003c/p\u003e\n\u003cp\u003eBest-corrected Snellen visual acuity was 3/60 in the affected eye, with relative afferent pupillary defect observed, and 6/9 contralaterally. Anterior segment examination was unremarkable. Right eye fundoscopy showed aneurysmal telangiectasia at the macula, 360 degrees perivascular sheathing and telangiectasia of peripheral retinal vessels. There was no exudation, neovascularization, tractional membranes, vitritis, retinitis and choroiditis. Left eye fundus was unremarkable. Optical coherence tomograph of the macula revealed disorganization and thinning of the inner retinal layers with minimal intraretinal fluid. Fundus fluorescein angiography showed leakage from the aneurysms, extensive peripheral capillary fallout and enlarged foveolar avascular zone. Blood investigations ruled out metabolic, infective, hematological and autoimmune causes. Carotid Doppler showed no stenosis and CT angiography of the brain did not show any vascular abnormalities. In view that no causes was identified, a diagnosis of idiopathic peripheral telangiectasia, possibly stage 1 Coats’ disease, was made. Treatment consisted of FFA-guided laser photocoagulation to the areas of non-perfusion. Intavitreal anti-vascular endothelial growth factor was not done in view of poor visual prognosis. The condition and visual acuity remained stable during 18 months of follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusion\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights the overlapping spectrum of retinal telangiectasia and its diagnostic challenges. Although stage 1 Coats’ disease could be a possibility, some features were atypical for this diagnosis. An inflammatory vasculitis with a secondary “Coats-like reaction” is postulated, but the exact etiology is still unknown.\u003c/p\u003e","manuscriptTitle":"Unilateral Retinal Telangiectasia with Peripheral Vascular Sheathing: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 18:40:45","doi":"10.21203/rs.3.rs-4564212/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-14T09:50:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-14T04:06:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-14T04:05:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2024-06-11T12:45:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b711242-b5f5-498e-a2fa-f370a99a87f8","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T16:01:06+00:00","versionOfRecord":{"articleIdentity":"rs-4564212","link":"https://doi.org/10.1186/s12886-024-03668-3","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2024-09-27 15:57:11","publishedOnDateReadable":"September 27th, 2024"},"versionCreatedAt":"2024-07-12 18:40:45","video":"","vorDoi":"10.1186/s12886-024-03668-3","vorDoiUrl":"https://doi.org/10.1186/s12886-024-03668-3","workflowStages":[]},"version":"v1","identity":"rs-4564212","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4564212","identity":"rs-4564212","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}