Klin Monbl Augenheilkd. 2006 Apr;223(4):271-8. doi: 10.1055/s-2006-926696.
New treatments for neovascular age-related macular degeneration have emerged recently, and data from phase III clinical trials are now available. In the light of these data, expert guidance appears prudent to aid ophthalmologists to select the most appropriate therapeutic strategy for the individual patient.
Therapeutic options discussed include laser photocoagulation, PDT with verteporfin, triamcinolone and its possible combination with PDT, anecortave acetate, pegaptanib and ranibizumab. Treatment principles are described and relevant clinical data summarized.
Extrafoveal classic CNVs should be treated with thermal laser coagulation. For subfoveal lesions with predominantly classic CNV, or occult forms with non-classic CNV, a lesion size < or = 4 macular photocoagulation study (MPS) disc areas (DA) and recent disease progression, PDT with verteporfin is a safe and efficacious treatment. For the remaining subtypes, VEGF inhibitors (pegaptanib, ranibizumab, bevacizumab) for intravitreal use are now available as therapeutic alternatives. The results of the phase III studies for pegaptanib and ranibizumab, however, are not comparable, in particular with reference to the outcomes in the control groups. Since bevacizumab and ranibizumab are comparable in their pharmacological profile bevacizumab may be an alternative in the off-label treatment of neovascular AMD. Reliable data concerning safety and efficacy for bevacizumab, however, are not available and there are no data on combination therapies. The switch to alternative treatment modalities should be considered in particular when the first line treatment is ineffective.
These recommendations provide evidence-based guidance for non-surgical therapies in the management of neovascular AMD. Revisions of the recommendations will be published when new data become available.
针对新生血管性年龄相关性黄斑变性的新疗法最近已出现，目前已有III期临床试验数据。鉴于这些数据，专家指导似乎有助于眼科医生为个体患者选择最合适的治疗策略。
讨论的治疗选择包括激光光凝、维替泊芬光动力疗法（PDT）、曲安奈德及其与PDT的联合应用、醋酸阿奈可他、培加尼布和兰尼单抗。描述了治疗原则并总结了相关临床数据。
黄斑中心凹外的典型脉络膜新生血管（CNV）应采用热激光凝固治疗。对于主要为典型CNV的黄斑中心凹下病变，或伴有非典型CNV的隐匿性病变，病变大小≤4个黄斑光凝研究（MPS）视盘面积（DA）且近期病情进展者，维替泊芬光动力疗法是一种安全有效的治疗方法。对于其余亚型，玻璃体内注射使用的血管内皮生长因子（VEGF）抑制剂（培加尼布、兰尼单抗、贝伐单抗）现在可作为治疗选择。然而，培加尼布和兰尼单抗的III期研究结果不可比，特别是在对照组的结果方面。由于贝伐单抗和兰尼单抗在药理学特性上具有可比性，贝伐单抗可能是新生血管性AMD非标签治疗的替代药物。然而，关于贝伐单抗安全性和有效性的可靠数据并不存在，也没有联合治疗的数据。当一线治疗无效时，应特别考虑改用其他治疗方式。
这些推荐为新生血管性AMD的非手术治疗提供了循证指导。有新数据时将发布推荐的修订版。
