Iu Lawrence P L, Kwok Alvin K H
Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong.
Hong Kong Med J. 2007 Dec;13(6):460-70.
To review the role of conventional and new treatment modalities in the management of neovascular age-related macular degeneration.
Literature search of Medline till March 2007, using the key words/terms 'treatment' and 'age-related macular degeneration' to retrieve relevant original papers and review articles.
Age-related macular degeneration is the leading cause of irreversible visual loss in the elderly in developed countries. Neovascular age-related macular degeneration has a relentless course and the consequent visual loss is debilitating. Successful treatment has always been a challenge due to poor understanding of its pathogenesis. Laser photocoagulation and photodynamic therapy with verteporfin are the standard conventional treatments. However, these approaches do not prevent disease recurrence and repeated treatments are required. Recent advances in understanding the molecular pathway for the angiogenesis of neovascular age-related macular degeneration enables exploration of new treatment approaches. Antiangiogenic therapy with anti-vascular endothelial growth factor agents, such as pegaptanib and ranibizumab, have recently been approved for clinical practice. Other antiangiogenic agents include bevacizumab, triamcinolone, and anecortave are also being evaluated in clinical trials. Additional treatment modalities include transpupillary thermotherapy and surgical intervention.
Regarding patients with neovascular age-related macular degeneration, increased understanding in its pathogenesis coupled with rapid development in instrumental technology and new/emerging medications greatly expands available treatment options. Despite these various therapeutic options, current treatment is mainly directed at achieving visual stabilisation. Restoration of vision with newer agents is limited and not possible in every patient. Thus, early recognition and treatment to arrest the progression of neovascular age-related macular degeneration is the preferred means of attaining the best visual outcome.
综述传统及新型治疗方式在新生血管性年龄相关性黄斑变性治疗中的作用。
检索截至2007年3月的Medline文献，使用关键词“治疗”和“年龄相关性黄斑变性”检索相关原始论文及综述文章。
年龄相关性黄斑变性是发达国家老年人不可逆视力丧失的主要原因。新生血管性年龄相关性黄斑变性病情进展迅速，随之而来的视力丧失使人衰弱。由于对其发病机制了解不足，成功治疗一直是一项挑战。激光光凝和维替泊芬光动力疗法是标准的传统治疗方法。然而，这些方法不能预防疾病复发，需要重复治疗。对新生血管性年龄相关性黄斑变性血管生成分子途径认识的最新进展使得探索新的治疗方法成为可能。抗血管内皮生长因子药物如培加尼布和兰尼单抗的抗血管生成疗法最近已被批准用于临床实践。其他抗血管生成药物包括贝伐单抗、曲安奈德和阿奈可他韦也正在临床试验中进行评估。其他治疗方式包括经瞳孔温热疗法和手术干预。
对于新生血管性年龄相关性黄斑变性患者，对其发病机制的深入了解，加上仪器技术和新出现药物的快速发展，极大地扩展了可用的治疗选择。尽管有这些不同的治疗选择，但目前的治疗主要旨在实现视力稳定。使用新型药物恢复视力有限，并非每个患者都能实现。因此，早期识别和治疗以阻止新生血管性年龄相关性黄斑变性的进展是获得最佳视力结果的首选方法。
