Inhoffen W, Ziemssen F
Department für Augenheilkunde, Universität Tübingen, Schleichstrasse 12-16, Tübingen, Germany.
Ophthalmologe. 2012 Aug;109(8):749-57. doi: 10.1007/s00347-011-2498-3.
Choroidal neovascularization due to pathological myopia (mCNV) differs in important characteristics from lesions seen in age-related macular degeneration (ARMD). Myopic CNV is associated with typical phenomena, such as lacquer cracks or patchy atrophy drusen or pigment epithelium detachment are rare occurrences. The dimensions of mCNV and the extent of leakage are substantially smaller. The heterogeneous combination of thinning and concomitant staphyloma often complicates the early detection of neovascular lesions. Diagnosis and evaluation of the clinical progress are only possible using the combination of different imaging modalities, e.g. funduscopy, fluorescein angiography (FLA) and spectral domain optical coherence tomography (SD-OCT). Special forms, such as periconal mCNV or dome-shaped variants exhibit a typical progression and response to therapy. In the course of the disease a progressive pigmentation and secondary atrophy occur and later, depigmentation of the mCNV complicates the demarcation of the original mCNV within the zone of atrophy. Extensive information and counselling seem to be mandatory in order to allow a better self-assessment. Sometimes, patients notice the first symptoms of recurrent mCNV activity before confirmation is possible by objective diagnostics.
病理性近视引起的脉络膜新生血管(mCNV)在重要特征上与年龄相关性黄斑变性(ARMD)中的病变不同。近视性CNV与典型现象相关,如漆裂纹或斑片状萎缩,玻璃膜疣或色素上皮脱离很少见。mCNV的大小和渗漏程度要小得多。变薄与伴随的葡萄肿的异质性组合常常使新生血管病变的早期检测复杂化。只有使用不同成像方式的组合,如眼底镜检查、荧光素血管造影(FLA)和光谱域光学相干断层扫描(SD-OCT),才能对临床进展进行诊断和评估。特殊形式,如圆锥周mCNV或穹顶形变体表现出典型的进展和对治疗的反应。在疾病过程中会出现进行性色素沉着和继发性萎缩,随后,mCNV的色素脱失会使萎缩区内原始mCNV的界限变得复杂。为了能更好地进行自我评估,广泛的信息和咨询似乎是必不可少的。有时,患者在客观诊断得以确认之前就注意到了复发性mCNV活动的最初症状。