Diagnosis and clinical features of non-exudative macular neovascularization

• Published in: Vestnik oftal'mologii Vol. 139; no. 1; p. 138
• Main Authors: Fursova, A Zh, Nikulich, I F, Gamza, Y A, Derbeneva, A S, Vasilyeva, M A, Tarasov, M S, Chubar, N V, Zubkova, M Yu
• Format: Journal Article
• Language: English; Russian
• Published: Russia (Federation) 2023
• Subjects: Choroid - diagnostic imaging; Choroid - pathology; Choroidal Neovascularization - diagnostic imaging; Fluorescein Angiography - methods; Humans; Retinal Pigment Epithelium; Retrospective Studies; Tomography, Optical Coherence - methods; Wet Macular Degeneration - pathology; macular neovascularization; optical coherence tomography; optical coherence tomography angiography; perfusion density; vessel density
• ISSN: 0042-465X
• DOI: 10.17116/oftalma2023139011138

Macular neovascularization (MNV) is the process of new abnormal blood vessels formation in the choroid and/or retina. The widespread adoption of optical coherence tomography angiography (OCTA) has significantly expanded the possibilities of not only detecting pathological blood flow before the development of exudation and deterioration of visual acuity, but also determining its characteristics. The purpose of this review is to substantiate the criteria for choosing terminology and diagnostic markers of MNV. The term "non-exudative MNV" refers to type 1 neovascularization without intraretinal or subretinal exudation detected on repeated OCT scans in the course of at least 6 months. This type of MNV may include previously untreated, non-exudative membranes with a low tendency to exudate, as well as previously treated membranes that have become inactive or dormant and no longer require anti-angiogenic therapy. The criterion for dividing the non-exudative form of MNV into inactive (with a low growth rate and vascular density (VD) at baseline) and subclinical (with a high growth rate and VD) is the time of its activation, generally recognized as 6 months. The diagnostic criteria is the visualized "double layer" sign on OCT scans (retinal pigment epithelium and Bruch's membrane), as well as patterns of neovascular membranes of varying sizes, morphology and localization on OCTA scans. The cumulative risk of conversion from subclinical to exudative at two years of follow-up is 13.6 times higher than in eyes without detectable neovascularization, which highlights the importance of frequent monitoring in this healthy eye population for early detection of MNV signs.