AGE-RELATED MACULAR DEGENERATION CURRENT INVESTIGATIONS AND TREATMENTS

agerelatedmaculardeg774enerationkapak

QUIESCENT MACULAR NEOVASCULARIZATION

Selda Çelik Dülger

Ankara Etlik City Hospital, Department of Ophthalmology, Ankara, Türkiye

Çelik Dülger S. Quiescent Macular Neovascularization. In: Çıtırık M, Şekeryapan Gediz B, editors. AgeRelated Macular Degeneration: Current Investigations and Treatments. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.157-168.

ABSTRACT

Quiescent macular neovascularization (MNV) is a type 1 choroidal neovascularization (CNV) that does not manifest as exudation on optical coherence tomography (OCT) within six months. On OCT, they appear as irregular retinal pigment epithelial elevations (RPE) with underlying material of moderate reflectivity. Late hyperfluorescent spots on fluorescein angiography (FA) that are not well circumscribed are seen as late hyperfluorescent plaques on indocyanine green angiography (ICGA). OCT angiography (OCTA) shows flow under the RPE and in the choriocapillaris. A cross-sectional OCT angiogram shows a vascular network structure between the RPE and Bruch’s membrane consistent with type 1 CNV. It is noteworthy that these lesions do not typically result in a decline in visual acuity unless they co-occur with central atrophy or exudation. The incidence and prevalence of these lesions vary across different studies, and they are recognized as a risk factor for exudative MNVs. In some studies, these lesions have been reported as a type of neovascularization characterized by a gradual activation rate. Predictive factors for exudation formation include decreased visual acuity, increased retinal thickness, increased diameter of pigment epithelial detachment on OCT, increased lesion area detected on OCTA, branching pattern, and hypointense halo around the lesion. In the absence of intra/ subretinal fluid with evidence of activation, sub-RPE hemorrhage, or gray hyperreflective subretinal exudative material, treatment is not recommended. Some quiescent MNVs should not be treated, even if growth is detected unless there is evidence of exudation. It has been suggested that these growing neovascular lesions may provide nutritional support for the underlying choroid and RPE. The protective effect of quiescent MNV has been reported to prevent the progression of geographic atrophy, and quiescent MNV is thought to provide oxygen to the hypoxic outer retina and choriocapillaris.

Keywords: Optical coherence tomography; Optical coherence tomography angiography; Fundus fluorescein angiography; Indocyanine green angiography; Macular degeneration; Choroidal neovascularization

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