Sartini Francesco, Figus Michele, Casini Giamberto, Nardi Marco, Posarelli Chiara
Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
Int Ophthalmol. 2020 Dec;40(12):3577-3589. doi: 10.1007/s10792-020-01522-1. Epub 2020 Jul 30.
The purpose of this paper is to provide a meaningful literature review about the epidemiology, pathogenesis, imaging and treatment of pachychoroid neovasculopathy (PNV).
A computerized search from inception up to December 2019 of the online electronic database PubMed was performed using the following search string: "pachychoroid neovasculopathy". The reference list in each article was scanned for additional relevant publications.
PNV is a type-1 choroidal neovascularization, overlying focal areas of choroidal thickening and dilated choroidal vessels. It can develop in patients affected by pachychoroid pigment epitheliopathy or chronic central serous chorioretinopathy. The absence of drusen, the presence of pachydrusen, younger age of onset and choroidal thickening distinguish it from neovascular age-related macular degeneration (AMD). PNV incidence and prevalence data are lacking. Its pathophysiology is not fully understood, but angiogenic mechanisms involved in neovascular AMD may be different from those in PNV. Due to optical coherence tomography (OCT) improvements, PNV can be diagnosed more easily than before. In particular, PNV shows a shallow pigment epithelium detachment with an undulating retinal pigment epithelium over a subfoveal choroidal thickening, associated with vein enlargement in Haller's layer (named pachyvessels) and choriocapillaris thinning. On OCT angiography, PNV reveals tangled hyper-reflective filamentous neovessels in the choriocapillaris itself. The current first-line PNV treatment is intravitreal anti-VEGF (vascular endothelial growth factor) injections with a treat-and-extend regimen. In particular, aflibercept shows a higher rate of fluid absorption than others. In the case of fluid recurrence or persistence, photodynamic therapy is a valid alternative.
Ongoing research into pathophysiology and imaging improvements may be helpful in defining prognostic criteria and stratifying patient risk, allowing responsible monitoring and management of PNV.
本文旨在提供一篇关于厚脉络膜新生血管病变（PNV）的流行病学、发病机制、影像学及治疗的有意义的文献综述。
使用以下检索词对在线电子数据库PubMed从起始至2019年12月进行计算机检索：“厚脉络膜新生血管病变”。对每篇文章的参考文献列表进行扫描以查找其他相关出版物。
PNV是1型脉络膜新生血管，覆盖脉络膜增厚和脉络膜血管扩张的局灶区域。它可发生于患有厚脉络膜色素上皮病变或慢性中心性浆液性脉络膜视网膜病变的患者。无玻璃膜疣、存在厚玻璃膜疣、发病年龄较轻以及脉络膜增厚将其与新生血管性年龄相关性黄斑变性（AMD）区分开来。缺乏PNV的发病率和患病率数据。其病理生理学尚未完全了解，但新生血管性AMD中涉及的血管生成机制可能与PNV中的不同。由于光学相干断层扫描（OCT）的改进，PNV比以前更容易诊断。特别是，PNV表现为黄斑下脉络膜增厚上方的浅色素上皮脱离，视网膜色素上皮呈波浪状，伴有Haller层静脉扩张（称为厚血管）和脉络膜毛细血管变薄。在OCT血管造影上，PNV显示脉络膜毛细血管本身有缠结的高反射丝状新生血管。目前PNV的一线治疗是采用治疗并延长方案的玻璃体内抗血管内皮生长因子（VEGF）注射。特别是，阿柏西普的液体吸收率高于其他药物。在液体复发或持续存在的情况下，光动力疗法是一种有效的替代方法。
对病理生理学和影像学改进的持续研究可能有助于确定预后标准并对患者风险进行分层，从而对PNV进行合理的监测和管理。
