Booth Blake A, Vidal Denham Lori, Bouhanik Saadallah, Jacob Jean T, Hill James M
Department of Ophthalmology, LSU Health Sciences Center, New Orleans, Louisiana, USA.
Drugs Aging. 2007;24(7):581-602. doi: 10.2165/00002512-200724070-00006.
Macular disease currently poses the greatest threat to vision in aging populations. Historically, most of this pathology could only be dealt with surgically, and then only after much damage to the macula had already occurred. Current pathophysiological insights into macular diseases have allowed the development of effective new pharmacotherapies. The field of drug delivery systems has advanced over the last several years with emphasis placed on controlled release of drug to specific areas of the eye. Its unique location and tendency toward chronic disease make the macula an important and attractive target for drug delivery systems, especially sustained-release systems. This review evaluates the current literature on the research and development of sustained-release posterior segment drug delivery systems that are primarily intended for macular disease with an emphasis on age-related macular degeneration.Current effective therapies include corticosteroids and anti-vascular endothelial growth factor compounds. Recent successes have been reported using anti-angiogenic drugs for therapy of age-related macular degeneration. This review also includes information on implantable devices (biodegradable and non-biodegradable), the use of injected particles (microspheres and liposomes) and future enhanced drug delivery systems, such as ultrasound drug delivery. The devices reviewed show significant drug release over a period of days or weeks. However, macular disorders are chronic diseases requiring years of treatment. Currently, there is no 'gold standard' for therapy and/or drug delivery. Future studies will focus on improving the efficiency and effectiveness of drug delivery to the posterior chamber. If successful, therapeutic modalities will significantly delay loss of vision and improve the quality of life for patients with chronic macular disorders.
黄斑疾病目前对老年人群的视力构成了最大威胁。从历史上看，大多数这类病变只能通过手术治疗，而且往往是在黄斑已经受到很大损害之后。目前对黄斑疾病病理生理学的深入了解使得有效的新药物疗法得以开发。在过去几年中，药物递送系统领域取得了进展，重点是将药物控释到眼部的特定区域。黄斑因其独特的位置和慢性病倾向，成为药物递送系统，尤其是缓释系统的重要且有吸引力的靶点。这篇综述评估了目前关于主要用于黄斑疾病，尤其是年龄相关性黄斑变性的缓释眼后段药物递送系统研发的文献。目前有效的治疗方法包括皮质类固醇和抗血管内皮生长因子化合物。最近有报道称使用抗血管生成药物治疗年龄相关性黄斑变性取得了成功。这篇综述还包括可植入装置（可生物降解和不可生物降解的）、注射颗粒（微球和脂质体）的使用以及未来增强型药物递送系统，如超声药物递送的相关信息。所综述的装置在数天或数周内显示出显著的药物释放。然而，黄斑疾病是需要数年治疗的慢性疾病。目前，治疗和/或药物递送没有“金标准”。未来的研究将集中于提高药物递送至后房的效率和效果。如果成功，治疗方式将显著延迟视力丧失，并改善慢性黄斑疾病患者的生活质量。
