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近视脉络膜新生血管:治疗综述,指南和共识声明 Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management

CMG, C., Arnold, J.J., Holz, F.G., et al.

期刊名称:Ophthalmology

卷期:2017年第124卷第11期

摘要

摘要:主题:本文旨在回顾和汇编有关近视脉络膜新生血管(CNV)分类,病理生理学和临床特征的可用信息,并描述这种疾病治疗的最新数据;并提供指南。临床意义:在美国,近视影响约3400万人(2010年),欧洲也有类似的数据。估计近视可能导致的病理性近视(PM)占全球人口的3%。 PM最为严重的并发症之一是近视性CNV,这种情况通常会导致中心视觉突然且进行性下降,如果不治疗的话,预后不良。此外,35%的近视性CNV患者在8年内对侧眼发病。尽管玻璃体内抗血管内皮生长因子(VEGF)治疗对近视性CNV患者的治疗产生了重大影响,但是我们对这种疾病的理解以及如何最好地进行治疗仍然存在很大差距。方法:我们对PubMed上的所有英文文章进行了文献回顾(20159月),检索关键词:“脉络膜新生血管”和“脉络膜新生血管”近视“或”近视性黄斑变性“或”退行性近视“或”近视黄斑病变“或”近视性视网膜病变“或”病理性近视“或”病理性近视。结果:共筛选出566篇摘要,250篇有全文评论。我们排除了另外的71篇,但另有44篇文章被确定。我们的这篇综述包括223篇文章。结论:中枢视力突然丧失的高度近视患者应进行进一步检查。一旦确诊为近视性CNV,在荧光素血管造影术后,除非禁忌,否则应及时开始抗VEGF药物一线治疗。需要对患者进行持续监测以评估病情的进展或复发。

TOPIC:The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance.CLINICAL RELEVANCE:In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti-vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown.METHODS:We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: "choroidal neovascularization" AND "myopia" OR "myopic macular degeneration" OR "degenerative myopia" OR "myopic maculopathy" OR "myopic retinopathy" OR "pathological myopia" OR "pathologic myopia."RESULTS:We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review.CONCLUSIONS:Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.


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