Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore.
Marsden Eye Specialists, Parramatta, Australia.
Ophthalmology. 2017 Nov;124(11):1690-1711. doi: 10.1016/j.ophtha.2017.04.028. Epub 2017 Jun 24.
The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance.
In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti-vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown.
We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: "choroidal neovascularization" AND "myopia" OR "myopic macular degeneration" OR "degenerative myopia" OR "myopic maculopathy" OR "myopic retinopathy" OR "pathological myopia" OR "pathologic myopia."
We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review.
Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.
本文旨在回顾和整理有关近视性脉络膜新生血管（CNV）的分类、病理生理学和临床特征的现有信息；描述该疾病管理的最新数据；并提出指导意见。
在美国，近视影响约 3400 万人（2010 年），欧洲也有类似的报告。病理性近视（PM）是近视的一种可能后果，据估计影响全球人口的 3%。PM 最严重的并发症之一是近视性 CNV，它常导致突发性但逐渐恶化的中心视力丧失，如果不治疗，预后往往较差。此外，35%的近视性 CNV 患者在 8 年内双眼相继发病。尽管玻璃体内抗血管内皮生长因子（VEGF）治疗对近视性 CNV 患者的治疗产生了重大影响，但我们对这种疾病的认识以及如何最佳治疗仍存在很大差距。此外，这些治疗方法的长期安全性和疗效在很大程度上仍不清楚。
我们对 PubMed 中所有英文文章进行了文献回顾（2015 年 9 月），检索了以下术语的文章：“脉络膜新生血管”和“近视”或“近视性黄斑变性”或“退行性近视”或“近视性黄斑病变”或“近视性视网膜病变”或“病理性近视”或“病理性近视”。
我们共筛选了 566 篇摘要，有 250 篇文章被认为与全文审查相关。我们进一步排除了 71 篇，但又确定了另外 44 篇。这导致了 223 篇文章用于本综述的编写。
高度近视患者出现突发性中心视力丧失时，应进一步检查。一旦确诊为近视性 CNV，在荧光素血管造影后，应尽快开始治疗，并考虑使用抗 VEGF 药物作为一线治疗方法，除非有禁忌症。需要对患者进行持续监测，以评估病情的任何进展或复发。
