Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
Eye (Lond). 2024 Jul;38(10):1836-1839. doi: 10.1038/s41433-024-03034-z. Epub 2024 Mar 18.
Macular neovascularization type 3 (MNV3) is a multifactorial disease with distinct epidemiological, clinical, pathomorphological and topographical characteristics. This review of the literature discusses the latest experimental and clinical outcomes that could explain the pathogenesis of retinal neovascularization. Although patients with MNV3 are usually older than those with MNV1 or 2, their lesions do not coexist with, precede, or follow other types in the same eye. The regional distribution of MNV3 lesions is characterized as confined to the parafoveal macula without any involvement of the rod-free foveal area. Focal outer retinal atrophy and choroidal non-perfusion are the main structural features that occur prior to the development of retinal neovascularization. Also, histological and experimental studies of MNV3 and other non-neovascular age-related macular degeneration diseases complicated with MNV3-like lesions strongly suggest rod degeneration contributes to the pathogenesis. Therefore, the retinal neovascularization in MNV3 has a different pathogenesis from the choroidal neovascularization in MNV1 and 2 and emerging evidence indicates that choroidal non-prefusion and rod degeneration play a key role in the pathogenesis of MNV3. Accordingly, we suggest a sequence of pathological events that start with choroidal non-perfusion due to advanced age followed by hypoxia of the outer retina at the parafoveal area. This induces a remarkable degeneration of rods that triggers the growth of retinal neovascularization due to the imbalance of the angiogenic factors in the outer retina.
黄斑新生血管 3 型（MNV3）是一种多因素疾病，具有独特的流行病学、临床、病理形态学和解剖学特征。本文对文献进行综述，讨论了最新的实验和临床结果，这些结果可以解释视网膜新生血管形成的发病机制。虽然 MNV3 患者通常比 MNV1 或 MNV2 患者年龄更大，但他们的病变并不与同一眼中的其他类型共存、先于或继其他类型之后。MNV3 病变的区域分布特征为局限于旁中心凹，黄斑区无任何杆状细胞无血管区受累。局灶性外视网膜萎缩和脉络膜无灌注是在视网膜新生血管形成之前发生的主要结构特征。此外，对 MNV3 及其他伴有 MNV3 样病变的非新生血管性年龄相关性黄斑变性疾病的组织学和实验研究强烈表明，杆状细胞变性有助于发病机制。因此，MNV3 中的视网膜新生血管形成与 MNV1 和 MNV2 中的脉络膜新生血管形成具有不同的发病机制，新出现的证据表明脉络膜无灌注和杆状细胞变性在 MNV3 的发病机制中起关键作用。因此，我们提出了一系列病理事件的顺序，首先是由于年龄增长导致脉络膜无灌注，接着是旁中心凹外视网膜缺氧，这会引起杆状细胞明显变性，由于外视网膜中血管生成因子的失衡，导致视网膜新生血管的生长。
