Kataoka Keiko, Gale Richard, Li Xiaoxin, Şermet Figen, Qian Cynthia X, Cheung Chui Ming Gemmy, Tsilimbaris Miltiadis K, Kozak Igor
Kyorin University School of Medicine, Tokyo, Japan.
Hull York Medical School, University of York and York Teaching Hospital NHS Foundation Trust, York, UK.
Graefes Arch Clin Exp Ophthalmol. 2025 Apr 14. doi: 10.1007/s00417-024-06721-5.
Understanding the clinical characteristics and underlying mechanisms of simultaneous geographic atrophy (GA) and choroidal neovascularization (CNV)/macular neovascularization (MNV) is necessary for the long-term management of late age-related macular degeneration (AMD) in clinical practice.
The authors reviewed the literature on the incidence, risk factors, and clinical characteristics of simultaneous GA and CNV/MNV and developed consensus recommendations for the diagnosis, assessment, and management of simultaneous GA and CNV/MNV in clinical practice.
The incidence rate of CNV/MNV in eyes with GA is reported as 7.4% per patient-year or 13.8% in 4.1 years, while that of macular atrophy (MA) subsequent to CNV/MNV is reported as 24.4% to 37% in 24 months. Recent studies using optical coherence tomography angiography (OCT-A) revealed the presence of subclinical CNV/MNV in 11% to 16% of eyes with GA. Fundus autofluorescence is used to detect MA; optical coherence tomography (OCT) and OCT-A are useful for detecting MA, especially around the fovea, with OCT-A offering high sensitivity and specificity in the detection of both MA and CNV/MNV. GA and CNV/MNV share the genetic risk factors of HTRA1, complement factor H, complement factors 3 and 2, and ARMS2, and clinical risk factors of large drusen, cuticular drusen, intraretinal hyperreflective foci, and subretinal drusenoid deposits, suggesting that simultaneous GA and CNV/MNV represents a continuum of AMD. Anti-vascular endothelial growth factor therapy for CNV/MNV is reported to have no impact on the speed or magnitude of MA development or enlargement. An association has been observed between CNV subtype and MA progression, with the latter being slower in the presence of type 1 CNV/MNV.
These findings suggest there is a high probability of coexistence of GA and CNV/MNV and that they should not be considered separately. Future clinical studies should assess the two conditions simultaneously using OCT and OCT-A.
What is known Owing to differences in their clinical characteristics, geographic atrophy (GA) and choroidal neovascularization (CNV)/macular neovascularization (MNV) have historically been regarded as two separate entities; however, several cases of coexistent GA and CNV/MNV have been reported recently in the published literature. What is new The findings of this review confirm that GA and CNV/MNV share common genetic risk factors and clinical characteristics, and suggest that these two entities are part of a continuum of late-stage age-related macular degeneration (AMD). The potential for GA and CNV/MNV to coexist should be considered in any discussion of the long-term management of late AMD; moreover, clinicians should assess for CNV/MNV in patients with GA, and for GA in those with CNV/MNV, using multimodal imaging.
了解同时存在地图样萎缩（GA）和脉络膜新生血管（CNV）/黄斑新生血管（MNV）的临床特征及潜在机制，对于临床实践中晚期年龄相关性黄斑变性（AMD）的长期管理至关重要。
作者回顾了关于同时存在GA和CNV/MNV的发病率、危险因素及临床特征的文献，并针对临床实践中同时存在GA和CNV/MNV的诊断、评估及管理制定了共识性建议。
据报道，GA眼中CNV/MNV的发病率为每年每位患者7.4%，或4.1年内为13.8%，而CNV/MNV继发的黄斑萎缩（MA）在24个月内的发病率为24.4%至37%。近期使用光学相干断层扫描血管造影（OCT-A）的研究显示，11%至16%的GA眼中存在亚临床CNV/MNV。眼底自发荧光用于检测MA；光学相干断层扫描（OCT）和OCT-A对检测MA很有用，尤其是在黄斑中心凹周围，OCT-A在检测MA和CNV/MNV方面具有高灵敏度和特异性。GA和CNV/MNV共享HTRA1、补体因子H、补体因子3和2以及ARMS2的遗传危险因素，以及大的玻璃膜疣、表皮玻璃膜疣、视网膜内高反射灶和视网膜下玻璃膜疣样沉积物等临床危险因素，这表明同时存在的GA和CNV/MNV代表了AMD的一个连续过程。据报道，针对CNV/MNV的抗血管内皮生长因子治疗对MA发展或扩大的速度或程度没有影响。已观察到CNV亚型与MA进展之间存在关联，在1型CNV/MNV存在的情况下，MA进展较慢。
这些发现表明GA和CNV/MNV共存的可能性很高，不应将它们分开考虑。未来的临床研究应使用OCT和OCT-A同时评估这两种情况。
已知情况 由于地理萎缩（GA）和脉络膜新生血管（CNV）/黄斑新生血管（MNV）的临床特征不同，它们在历史上一直被视为两个独立的实体；然而，最近在已发表的文献中报道了几例GA和CNV/MNV共存的病例。新发现 本综述的结果证实，GA和CNV/MNV共享共同的遗传危险因素和临床特征，并表明这两个实体是晚期年龄相关性黄斑变性（AMD）连续过程的一部分。在任何关于晚期AMD长期管理的讨论中，都应考虑GA和CNV/MNV共存的可能性；此外，临床医生应使用多模态成像对GA患者评估是否存在CNV/MNV，对CNV/MNV患者评估是否存在GA。
