Meyer C H, Helb H-M, Eter N
Augenklinik, Universitätsklinikum Bonn, Ernst-Abbe-Strasse 2, 53127, Bonn, Germany.
Ophthalmologe. 2008 Feb;105(2):125-38, 140-2. doi: 10.1007/s00347-008-1702-6.
Age-related macular degeneration (AMD) is one of the most common causes of blindness in western industrialised nations. Most AMD patients suffer from the dry early form of AMD; however, wet AMD with choroidal neovascularization (CNV) is the main cause of blindness in all AMD patients. New prospects have been developed in AMD treatment using pharmacological methods available for treating all subtypes of exudative AMD. A number of inhibiting and inducing growth factors, such as vascular endothelial growth factor (VEGF), are particularly important in the pathophysiology of wet AMD. The secreted VEGF appears to play a crucial role in the pathogenesis of CNV and macular edemas as a result of its angiogenetic and permeability-enhancing effect. This recognition led to the treatment approach now used, i.e., competitive VEGF blocking through intravitreal adminsitration of anti-VEGF drugs. The anti-VEGF durgs lead to a rapid decrease in retinal thickness. Optical coherence tomography (OCT) is a valuable monitoring tool, but may only be used to assist in decision-making. Clinical follow-up of patients and further treatment recommendations must always be guided by the overall clinical picture. Visual acuity is regarded as the decisive criterion for repeat treatment.
年龄相关性黄斑变性(AMD)是西方工业化国家最常见的致盲原因之一。大多数AMD患者患有早期干性AMD;然而,伴有脉络膜新生血管(CNV)的湿性AMD是所有AMD患者失明的主要原因。利用可用于治疗所有渗出性AMD亚型的药理学方法,AMD治疗已出现新的前景。一些抑制和诱导生长因子,如血管内皮生长因子(VEGF),在湿性AMD的病理生理学中尤为重要。分泌的VEGF由于其血管生成和增强通透性的作用,似乎在CNV和黄斑水肿的发病机制中起关键作用。这一认识导致了目前使用的治疗方法,即通过玻璃体内注射抗VEGF药物进行竞争性VEGF阻断。抗VEGF药物可使视网膜厚度迅速降低。光学相干断层扫描(OCT)是一种有价值的监测工具,但仅可用于辅助决策。患者的临床随访和进一步的治疗建议必须始终以整体临床情况为指导。视力被视为重复治疗的决定性标准。