Iida Tomohiro, Gomi Fumi, Yasukawa Tsutomu, Yamashiro Kenji, Honda Shigeru, Maruko Ichiro, Kataoka Keiko
Department of Ophthalmology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, Japan.
Department of Ophthalmology, Ageo Central General Hospital, Ageo, Japan.
Jpn J Ophthalmol. 2025 Jul 14. doi: 10.1007/s10384-025-01240-0.
Recent advances in imaging technology and increased options of pharmaceutical therapy require that guidelines on the diagnostic criteria and treatment of neovascular age-related macular degeneration (AMD) be updated at regular intervals. These guidelines aim to standardize the management of neovascular AMD based on the latest understanding of its pathophysiology, advancements in diagnostic imaging modalities, and treatment options. The key updates include: (1) a revision of terminology and stage classification, adopting the AMD classifications of atrophic and neovascular, and adding end-stage AMD to the existing early, intermediate, and late stages; (2) the inclusion of pachychoroid in addition to drusen in the initial pathophysiology and pathogenic background; (3) diagnostic criteria defined by the presence of macular neovascularization based on multimodal imaging, including optical coherence tomography (OCT) and OCT angiography; (4) assessment of disease activity based on OCT; and (5) treatment guidance, including prophylaxis and low vision care as well as loading and maintenance phases by use of anti-vascular endothelial growth factor therapy and adjunctive therapies. We hope that these guidelines will be useful for those working in clinical practice in Japan, in other Asian countries, and in countries outside Asia.
成像技术的最新进展以及药物治疗选择的增加，要求定期更新新生血管性年龄相关性黄斑变性（AMD）的诊断标准和治疗指南。这些指南旨在根据对其病理生理学的最新认识、诊断成像方式的进展以及治疗选择，规范新生血管性AMD的管理。关键更新包括：（1）修订术语和阶段分类，采用萎缩性和新生血管性AMD分类，并在现有的早期、中期和晚期阶段中增加晚期AMD；（2）在初始病理生理学和致病背景中，除了玻璃膜疣外还纳入了厚脉络膜；（3）基于多模态成像（包括光学相干断层扫描（OCT）和OCT血管造影）定义的黄斑新生血管形成的诊断标准；（4）基于OCT评估疾病活动；（5）治疗指导，包括预防和低视力护理，以及使用抗血管内皮生长因子疗法和辅助疗法的负荷期和维持期。我们希望这些指南对在日本、其他亚洲国家以及亚洲以外国家从事临床实践的人员有用。
