Sheth Jay U, Stewart Michael W, Narayanan Raja, Anantharaman Giridhar, Chandran Kiran, Lai Timothy Y Y, Chakravarthy Usha, Das Taraprasad
Department of Vitreoretinal Services, Shantilal Shanghvi Eye Institute, Mumbai, India.
Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.
Surv Ophthalmol. 2025 Jul-Aug;70(4):653-675. doi: 10.1016/j.survophthal.2024.08.003. Epub 2024 Aug 31.
Neovascularization of the macula, a common complication of many chorioretinal diseases such as neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and pathologic myopia, results from increased synthesis of vascular endothelial growth factor (VEGF) by the retinal pigment epithelium and/or Müller cells because of localized ischemia and inflammation. The Consensus on Neovascular AMD Nomenclature (CONAN) study group acknowledged that these vessels may originate from either the choriocapillaris or the retinal microvasculature, prompting them to propose the term 'macular neovascularization' (MNV) to include intraretinal, subretinal, and sub-pigment epithelial neovascularization localized to the macula. MNV frequently appears as a grey-green macular lesion with overlying intraretinal thickening and/or subretinal exudation, causing metamorphopsia, reduced central vision, relative central scotoma, decreased reading speed, and problems with color recognition. Multimodal imaging with optical coherence tomography (OCT), OCT angiography, dye-based angiographies, fundus autofluorescence, and multiwavelength photography help establish the diagnosis and aid in selecting an appropriate treatment. The standard of care for MNV is usually intravitreal anti-vascular endothelial growth factor injections, though thermal laser photocoagulation, verteporfin photodynamic therapy, and vitreoretinal surgery are occasionally used. We discuss the etiology and clinical features of MNV, the role of multimodal imaging in establishing the diagnosis, and the available therapeutic options.
黄斑新生血管形成是许多脉络膜视网膜疾病的常见并发症，如新生血管性年龄相关性黄斑变性、息肉状脉络膜血管病变和病理性近视，它是由于视网膜色素上皮和/或Müller细胞因局部缺血和炎症导致血管内皮生长因子（VEGF）合成增加所致。新生血管性年龄相关性黄斑变性命名共识（CONAN）研究小组承认，这些血管可能起源于脉络膜毛细血管或视网膜微血管系统，因此他们提出了“黄斑新生血管形成”（MNV）这一术语，以涵盖局限于黄斑的视网膜内、视网膜下和色素上皮下新生血管形成。MNV常表现为黄斑区灰绿色病变，伴有视网膜内增厚和/或视网膜下渗出，可导致视物变形、中心视力下降、相对中心暗点、阅读速度减慢以及颜色识别问题。光学相干断层扫描（OCT）、OCT血管造影、染料血管造影、眼底自发荧光和多波长摄影等多模态成像有助于确诊并辅助选择合适的治疗方法。MNV的标准治疗通常是玻璃体内注射抗血管内皮生长因子，不过有时也会使用热激光光凝、维替泊芬光动力疗法和玻璃体视网膜手术。我们将讨论MNV的病因和临床特征、多模态成像在诊断中的作用以及现有的治疗选择。
