Balaskas Konstantinos, Amoaku Winfried M, Cudrnak Tomas, Downey Louise M, Groppe Markus, Mahmood Sajjad, Mehta Hemal, Mohamed Quresh, Mushtaq Bushra, Severn Philip, Vardarinos Athanasios, Yang Yit C
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and University College of London Institute of Ophthalmology, London, UK.
Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
Ophthalmol Ther. 2021 Jun;10(2):231-243. doi: 10.1007/s40123-021-00342-5. Epub 2021 Apr 10.
Neovascular age-related macular degeneration (nAMD) presents a significant treatment burden for patients, carers and medical retina services. However, significant debate remains regarding how best to manage nAMD when assessing disease activity by optical coherence tomography (OCT), and particularly the significance of different types of fluid and how the understanding of anatomical efficacy can influence treatment strategies. This article provides opinion on the practical implications of anatomical efficacy and significance of fluid in the management of nAMD and proposes recommendations for healthcare professionals (HCPs) to improve understanding and promote best practice to achieve disease control.
An evidence-based review was performed and an expert panel debate from the Retina Outcomes Group (ROG), a forum of retinal specialists, provided insights and recommendations on the definition, role and practical implications of anatomical efficacy and the significance of fluid at the macula in the management of nAMD.
The ROG has developed recommendations for achieving disease control through a zero-tolerance approach to the presence of fluid in nAMD as patients who avoid fluctuations in fluid at the macula have better visual outcomes. Recommendations cover five key areas: service protocol, training, regimen, multidisciplinary teams and engagement. This approach facilitates more standardised protocol-based treatment strategies.
Targeting a fluid-free macula and aiming for disease control are essential to improve outcomes. As new therapies and technologies become available, drying the macula and maintaining disease control will become even more achievable. The outlined recommendations aim to promote best practice among HCPs and medical retina services to improve patient outcomes.
新生血管性年龄相关性黄斑变性（nAMD）给患者、护理人员和医学视网膜服务带来了巨大的治疗负担。然而，在通过光学相干断层扫描（OCT）评估疾病活动时，对于如何最佳管理nAMD仍存在重大争议，特别是不同类型积液的意义以及对解剖学疗效的理解如何影响治疗策略。本文就解剖学疗效和积液在nAMD管理中的意义的实际影响发表意见，并为医疗保健专业人员（HCP）提出建议，以增进理解并推广最佳实践以实现疾病控制。
进行了基于证据的综述，视网膜结果小组（ROG）——一个视网膜专家论坛——的专家小组辩论提供了关于解剖学疗效的定义、作用和实际影响以及黄斑区积液在nAMD管理中的意义的见解和建议。
ROG制定了通过对nAMD中积液采取零容忍方法来实现疾病控制的建议，因为避免黄斑区积液波动的患者有更好的视觉结果。建议涵盖五个关键领域：服务方案、培训、治疗方案、多学科团队和参与。这种方法有助于采用更标准化的基于方案的治疗策略。
以黄斑无积液为目标并致力于疾病控制对于改善治疗结果至关重要。随着新疗法和技术的出现，使黄斑干燥并维持疾病控制将变得更加可行。概述的建议旨在促进HCP和医学视网膜服务之间的最佳实践，以改善患者治疗结果。
