Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France, Lyon, France.
Eye (Lond). 2023 Jun;37(9):1758-1765. doi: 10.1038/s41433-022-02231-y. Epub 2022 Sep 14.
The aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.
本综述旨在确定不同新生血管性年龄相关性黄斑变性（nAMD）亚型的共同特征和预后。我们还提出了根据新生血管亚型定制治疗方案的建议，以优化患者的治疗效果。本文的作者是视觉学会的选定成员，他们根据文献检索（截止日期：2019 年 3 月）在PubMed 数据库上的证据，讨论了 nAMD 中根据黄斑新生血管（MNV）亚型进行的治疗结果。这篇综述总结了视觉学会关于如何通过 MNV 亚型的特征来优化 nAMD 治疗效果的建议。多模态成像技术的出现促进了 MNV 亚型的识别。荧光素血管造影、吲哚青绿血管造影和谱域光学相干断层扫描的综合结果有助于细化和标准化 MNV 亚型的确定。迄今为止，文献中已经描述了三种亚型，并且具有特定的特征，这些特征是通过成像确定的。1 型 MNV 与更好的长期预后相关，但通常需要更密集的抗血管内皮生长因子治疗。2 型 MNV 通常对治疗反应迅速，但更容易形成纤维性瘢痕，这可能与较差的预后相关。3 型 MNV 通常对血管内皮生长因子治疗高度敏感，但与其他亚型相比，可能更容易发生外层视网膜萎缩。准确评估 MNV 亚型可提供预后信息，并有助于优化 nAMD 患者的管理。
