Introduction: Macular telangiectasia type 2 (MacTel 2) is a chronic degenerative retinal disease. In everyday ophthalmic practice, both its early and advanced stages pose significant diagnostic and therapeutic challenges. The aim of this paper is to discuss novel therapeutic options reported in the literature and to present a proposed diagnostic and therapeutic management strategy for patients with advanced disease complicated by secondary pathologies. Case report: A 57‑year‑old otherwise healthy woman presented with deterioration of both near and distance vision despite using her current spectacles. Multimodal retinal imaging confirmed the diagnosis of macular telangiectasia type 2. Due to the presence of active neovascularization, the patient was scheduled for intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Following the injection, best-corrected visual acuity initially improved and has remained stable thereafter. Conclusions: MacTel 2 is a condition encountered in routine clinical practice. Since 2025, the first gene therapy – revakinagene taroretcel (Encelto) – has been approved in the United States for the treatment of the non-proliferative form of the disease. In cases complicated by macular neovascularization, intravitreal administration of anti-vascular endothelial growth factor agents is required.