Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Acta Ophthalmol. 2022 Feb;100(1):e270-e277. doi: 10.1111/aos.14866. Epub 2021 Apr 5.
BACKGROUND/AIMS: To explore whether the existence and pattern of distribution of macular haemorrhage or exudate can be valuable diagnostic markers for macular neovascularization type 3 (MNV3) in patients with neovascular age-related macular degeneration.
Eighty-three eyes of 83 consecutive treatment naïve patients with stage 3 MNV3 were enrolled. The diagnosis was based on fluorescein angiography (FA) and optical coherence tomography (OCT). Subretinal and intraretinal haemorrhage and dense exudates were evaluated on colour fundus photography. Fluorescein angiography (FA) images and OCT scans were used to identify the axial location of the haemorrhage. 83 patients with MNV1 and 83 with MNV2 were included as two control groups.
In the MNV3 group, 62 (75%) eyes had intraretinal haemorrhage and 52 (63%) had dense exudates. 73 (88%) eyes had intraretinal haemorrhage and/or dense exudates. 41 (49%) had both pathologies. The intraretinal haemorrhage was flame shaped over the lesion and punctate or semi-punctate further away from it and directed to the fovea. No subretinal haemorrhage was noticed. In the MNV1 and MNV2 groups, 11 (13%) and 24 (29%) eyes had subretinal haemorrhage or dense exudates, respectively. No intraretinal haemorrhage was seen in the two control groups. The prevalence of exudates and haemorrhage (irrespective of its location) was greater in MNV3 than in MNV1 or 2 (p < 0.0001).
The existence and pattern of distribution of intraretinal haemorrhage is pathognomonic of MNV3. It makes (alone or with dense exudates) the diagnose MNV3 possible using fundoscopy or colour fundus photo and without further diagnostic expenditure.
背景/目的：探讨黄斑出血或渗出的存在和分布模式是否可作为新生血管性年龄相关性黄斑变性患者 3 型黄斑新生血管（MNV3）的有价值的诊断标志物。
纳入 83 例连续未经治疗的 3 期 MNV3 患者的 83 只眼。诊断基于荧光素血管造影（FA）和光学相干断层扫描（OCT）。眼底彩色照相评估视网膜下和视网膜内出血和密集渗出。使用 FA 图像和 OCT 扫描来确定出血的轴向位置。纳入 83 例 MNV1 和 83 例 MNV2 作为两组对照。
在 MNV3 组中，62 只（75%）眼有视网膜内出血，52 只（63%）眼有密集渗出。73 只（88%）眼有视网膜内出血和/或密集渗出。41 只（49%）眼同时存在两种病变。视网膜内出血呈火焰状位于病变上方，远离病变处呈点状或半点状，并指向黄斑。未发现视网膜下出血。在 MNV1 和 MNV2 组中，11 只（13%）和 24 只（29%）眼分别有视网膜下出血或密集渗出。两个对照组均未见视网膜内出血。MNV3 组渗出物和出血（无论其位置如何）的患病率均高于 MNV1 或 2 组（p<0.0001）。
视网膜内出血的存在和分布模式是 MNV3 的特征。它使得（单独或伴有密集渗出物）仅凭眼底检查或眼底彩色照相即可诊断 MNV3，而无需进一步的诊断性检查。
