Mitchell Eye Centre, Calgary, Alberta, Canada; Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.
Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.
Surv Ophthalmol. 2015 May-Jun;60(3):204-15. doi: 10.1016/j.survophthal.2014.10.002. Epub 2014 Nov 5.
Choroidal neovascular membranes (CNVM) associated with pathological myopia (PM) can result in significant vision loss and legal blindness. These membranes usually occur subfoveally and are a major complication of PM, developing in approximately 5-10% of such eyes. PM is the second most common cause of choroidal neovascularization after age-related macular degeneration (AMD), and accounts for nearly 60% of CNVM cases in patients younger than age 50. Vascular endothelial growth factor-A has been implicated as the major angiogenic stimulus responsible for choroidal neovascularization secondary to AMD and several major studies have proved the benefits of anti-VEGF treatment for AMD-related CNVM. Benefits have also been observed in a number of prospective and retrospective studies evaluating PM CNVM. Despite the small differences in molecular properties of ranibizumab and bevacizumab, both drugs showed similar therapeutic effects for CNVM associated with PM. Many studies also highlighted that patient age, previous photodynamic therapy treatment, axial length, and visual acuity prior to treatment may affect treatment prognosis. Although there is a paucity of large randomized controlled trials, this systematic review highlights the large numbers of individual trials that demonstrate a significant improvement in VA. The inferior long-term results of alternative therapies, combined with an excellent safety profile from anti-VEGF treatment, make anti-VEGF the current recommended first-line therapy.
脉络膜新生血管膜（CNVM）与病理性近视（PM）相关，可导致严重视力丧失和法定失明。这些膜通常位于黄斑下，是 PM 的主要并发症，约 5-10%的 PM 眼会发生这种情况。PM 是继年龄相关性黄斑变性（AMD）之后第二常见的脉络膜新生血管形成原因，占 50 岁以下患者 CNVM 病例的近 60%。血管内皮生长因子-A 被认为是导致 AMD 继发脉络膜新生血管形成的主要血管生成刺激物，几项主要研究已经证明了抗 VEGF 治疗 AMD 相关 CNVM 的益处。在评估 PM CNVM 的多项前瞻性和回顾性研究中也观察到了益处。尽管雷珠单抗和贝伐单抗在分子特性上存在微小差异，但这两种药物对 PM 相关 CNVM 的治疗效果相似。许多研究还强调，患者年龄、既往光动力疗法治疗、眼轴长度和治疗前视力可能会影响治疗预后。尽管缺乏大型随机对照试验，但本系统评价强调了大量的个体试验表明 VA 显著改善。替代疗法的长期结果较差，加上抗 VEGF 治疗的良好安全性，使得抗 VEGF 成为目前推荐的一线治疗方法。
