Unit of Ophthalmology, School of Clinical Sciences, University of Liverpool, Liverpool, UK.
Eye (Lond). 2010 Mar;24(3):497-505. doi: 10.1038/eye.2009.316. Epub 2010 Jan 8.
To review the decision-making processes and dilemmas in the delivery of services for neovascular age-related macular degeneration (nAMD) and describe its optimal management.
Review of literature and presentation of illustrative cases.
Guidelines are available to aid commissioners and providers of services but with important gaps in advice. Increasing awareness of variants and diseases that mimic nAMD means that clinicians need to carefully assess lesions at presentation, using stereo imaging, fluorescein and indocyanine green angiography, and new generation optical coherence tomography. Current evidence supports the use of ranibizumab as first-line therapy. Evidence is unclear on the most appropriate treatment regime, especially in protocols relying on clinician-determined re-treatment. Current consensus recommends initiation with monthly injections for 3 months followed by maintenance comprising regular monthly visits with clinician-determined re-treatment. Further evidence on treatment protocols and the comparison with bevacizumab is awaited.
Owing to incomplete evidence base health professionals face a large number of controversies and dilemmas in care pathways for patients with nAMD. Treatment should be delivered against protocols developed locally in a systematic manner with consensus and a cautious approach to change.
回顾新生血管性年龄相关性黄斑变性（nAMD）治疗服务中的决策过程和困境，并描述其最佳管理方法。
文献回顾和案例说明。
有指南可以帮助服务的管理者和提供者，但在建议方面存在重要的空白。对与 nAMD 类似的变异体和疾病的认识不断提高，这意味着临床医生需要在就诊时使用立体成像、荧光素和吲哚青绿血管造影以及新一代光学相干断层扫描仔细评估病变。目前的证据支持将雷珠单抗作为一线治疗药物。在治疗方案中，特别是在依赖临床医生确定的再治疗方案的方案中，证据尚不清楚。目前的共识建议最初每月注射 3 个月，然后进行维持治疗，包括定期每月进行临床医生确定的再治疗。正在等待关于治疗方案的进一步证据以及与贝伐单抗的比较。
由于证据基础不完整，卫生专业人员在 nAMD 患者的护理路径中面临许多争议和困境。治疗应按照当地制定的方案系统地进行，同时要达成共识，并谨慎地进行方案调整。
