Vitreous, Retina, Macula Consultants of New York, New York, New York.
LuEsther T. Mertz Retina Research Laboratory, New York, New York.
Retina. 2018 May;38(5):891-899. doi: 10.1097/IAE.0000000000001732.
Previous models of disease in age-related macular degeneration (AMD) were incomplete in that they did not encompass subretinal drusenoid deposits (pseudodrusen), subtypes of neovascularization, and polypoidal choroidal vasculopathy. In addition, Type 3 neovascularization starts in the retina and may not necessarily involve the choroid. As such, the term choroidal neovascularization is not appropriate for these eyes. The new aspects in the AMD construct are to include specific lipoprotein extracellular accumulations, namely drusen and subretinal drusenoid deposits, as early AMD. The deposition of specific types of deposit seems to be highly correlated with choroidal thickness and topographical location in the macula. Late AMD includes macular neovascularization or atrophy. The particular type of extracellular deposit is predictive of the future course of the patient. For example, eyes with subretinal drusenoid deposits have a propensity to develop outer retinal atrophy, complete outer retinal and retinal pigment epithelial atrophy, or Type 3 neovascularization as specific forms of late AMD. Given Type 3 neovascularization may never involve the choroid, the term macular neovascularization is suggested for the entire spectrum of neovascular disease in AMD. In contrast to older classification systems, the proposed system encompasses the relevant presentations of disease and more precisely predicts the future course of the patient. In doing so, the concept was developed that there may be genetic risk alleles, which are not necessarily the same alleles that influence disease expression.
先前的年龄相关性黄斑变性（AMD）疾病模型存在缺陷，因为它们没有包含视网膜下类脂沉积（假性玻璃膜疣）、新生血管亚型和息肉样脉络膜血管病变。此外，3 型新生血管起始于视网膜，不一定涉及脉络膜。因此，这些眼睛不适合使用脉络膜新生血管这个术语。AMD 结构中的新方面是将特定的脂蛋白细胞外积聚，即玻璃膜疣和视网膜下类脂沉积，作为早期 AMD。特定类型沉积物的沉积似乎与脉络膜厚度和黄斑的位置高度相关。晚期 AMD 包括黄斑新生血管或萎缩。特定类型的细胞外沉积物可预测患者的未来病程。例如，有视网膜下类脂沉积的眼睛易发生外层视网膜萎缩、完全的外层视网膜和视网膜色素上皮萎缩，或作为晚期 AMD 的特定形式出现 3 型新生血管。由于 3 型新生血管可能从未涉及脉络膜，因此建议使用“黄斑新生血管”术语来描述 AMD 中新生血管疾病的整个谱。与旧的分类系统相比，该提议的系统涵盖了相关的疾病表现，并更准确地预测了患者的未来病程。这样做的同时，提出了一个概念，即可能存在遗传风险等位基因，这些等位基因不一定与影响疾病表达的等位基因相同。
