Characterisation of macular neovascularisation subtypes in age-related macular degeneration to optimise treatment outcomes.

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. 摘要: 本综述的目的是确定新生血管性年龄相关性黄斑变性 (nAMD) 不同亚型的特征和预后.并建议如何根据新生血管的亚型调整治疗方案, 以优化患者的预后.作者为视觉学会的选定成员, 根据黄斑区新生血管 (MNV) 的不同亚型, 利用PubMed数据库中检索的文献 (截止日期: 2019年3月),讨论了nAMD的治疗效果.这篇综述文章总结了视觉学会关于不同MNV亚型如何优化nAMD治疗结果的建议.多模式成像促进了MNV亚型的识别.荧光素血管造影术、吲哚菁绿血管造影术和谱域光学相干断层扫描的结果共同完善并标准化了MNV亚型的确定.迄今为止,文献中已经描述了三种亚型,并通过成像确定了它们的具体特征.1型MNV具有更好的长期预后,但通常需要更高剂量的抗血管内皮生长因子.2型MNV通常对治疗反应迅速,但更容易形成纤维化瘢痕,这可能与较差的预后相关.3型MNV往往对抗血管内皮生长因子治疗高度敏感,但与其他亚型相比,可能与更高的视网膜外萎缩发生率相关.准确评估MNV的亚型可提供预后的信息,并有助于优化nAMD患者的管理.

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