Wykrota Halina, Gierek-Lapińska Ariadna, Trzciakowski Krzysztof, Gajdzik-Gajdecka Urszula
Samodzielny Publiczny Szpital Kliniczny Nr 5 Slaskiego Uniwersytetu Medycznego w Katowicach.
Klin Oczna. 2007;109(10-12):402-9.
It is commonly agreed nowadays that one of the key elements of neovascular age-related macular degeneration (AMO) pathogenesis is deregulation of the angiogenesis factors. Treatment of subfoveal choroidal neovascularizations (CNV) in course of AMD was limited to photodynamic therapy with verteporfin (PDT). The new approach to CNV treatment is to discover and eliminate factors, which directly induce CNV development. Extended studies have allowed to employ inhibitors of vascular endothelial growth factor (VEGF) for a treatment of neovascular AMD. Numerous of anti-VEGF compounds are still under developing in pre-clinical or phase-1/2 clinical studies whereas 2 of them have completed phase 3 of clinical trials. The newest compound that was launched on drug market is ranibizumab (Lucentis). Ranibizumab is a recombinant humanized IgG1 isotype, monoclonal antibody fragment designed for intravitreal use. Ranibizumab binds to and inhibits the biologic activity of human vascular endothelial growth factor A (VEGF-A). It has been proved on the base of MARINA and ANCHOR clinical trials that treatment ranibizumab is effective and save for patients treated for CNV secondary to AMD.
Interventional case series.
67 eyes of 67 patients with all angiographic subtypes of wet AMD were treated with 0.5 mg of intravitreal ranibizumab, injected monthly for first 3 doses. Next doses were injected according to specified re-treatment criteria as assessed in monthly follow-up.
Mean change in visual acuity (VA) was +12.4 ETDRS letters. Percent of patient losing less than 15 ETDRS letters was 93.2%. Percent of patient gaining VA more than 3 ETDRS letters was 43.4%.
Intravitreal ranibizumab is effective in treatment of CNV due to AMD. A significant number of patients have improved theirs VA. Implementation of anti-VEGF therapy for treatment of ocular diseases gave a new hope for patient that previously couldn't be treated with any of method.
如今人们普遍认为，新生血管性年龄相关性黄斑变性（AMD）发病机制的关键要素之一是血管生成因子的失调。在AMD病程中，对黄斑下脉络膜新生血管（CNV）的治疗仅限于使用维替泊芬进行光动力疗法（PDT）。CNV治疗的新方法是发现并消除直接诱导CNV形成的因素。广泛的研究使得血管内皮生长因子（VEGF）抑制剂可用于治疗新生血管性AMD。许多抗VEGF化合物仍处于临床前或1/2期临床试验开发阶段，而其中两种已完成3期临床试验。最新投放市场的化合物是雷珠单抗（Lucentis）。雷珠单抗是一种重组人源化IgG1同种型单克隆抗体片段，设计用于玻璃体内注射。雷珠单抗可结合并抑制人血管内皮生长因子A（VEGF-A）的生物活性。基于MARINA和ANCHOR临床试验已证明，雷珠单抗治疗对继发于AMD的CNV患者有效且安全。
干预性病例系列研究。
对67例患有各种血管造影亚型湿性AMD的患者的67只眼，给予0.5mg玻璃体内注射雷珠单抗，前3剂每月注射1次。后续剂量根据每月随访评估的特定再治疗标准进行注射。
视力（VA）平均变化为+12.4个ETDRS字母。视力下降少于15个ETDRS字母的患者比例为93.2%。视力提高超过3个ETDRS字母的患者比例为43.4%。
玻璃体内注射雷珠单抗对治疗AMD所致的CNV有效。大量患者的视力得到改善。抗VEGF疗法用于治疗眼部疾病为以前无法用任何方法治疗的患者带来了新希望。
