Shao Jack, Choudhary Maria M, Schachat Andrew P
Dev Ophthalmol. 2016;55:125-36. doi: 10.1159/000438969. Epub 2015 Oct 26.
Age-related macular degeneration (AMD) is the leading cause of severe vision loss in individuals over the age of 50 years. Choroidal neovascularization (CNV) is the hallmark of 'wet' or 'exudative' AMD, and is responsible for approximately 90% of cases of severe vision loss due to AMD. Vascular endothelial growth factor (VEGF) is a key component in the development and progression of wet AMD. Since the approval of ranibizumab in 2006, VEGF inhibitors have rapidly altered the treatment and standard of care for wet AMD. Ranibizumab, bevacizumab, and aflibercept are now the most widely used anti-VEGF agents for the treatment of wet AMD. This chapter discusses the pharmacologic properties, pharmacokinetics, safety, and efficacy of these medications, as well as revisits landmark clinical trials that establish these drugs as gold standards in care. While these medications have greatly and positively altered the way we treat AMD, there are still many economic and therapeutic limitations with our current therapy regimens. There continue to be advancements and innovations in exploring alternative and new treatment modalities, as well as combining existing treatment options to improve efficacy, and reduce cost and patient burden.
年龄相关性黄斑变性（AMD）是50岁以上人群严重视力丧失的主要原因。脉络膜新生血管形成（CNV）是“湿性”或“渗出性”AMD的标志，约90%的AMD所致严重视力丧失病例与之有关。血管内皮生长因子（VEGF）是湿性AMD发生发展的关键因素。自2006年雷珠单抗获批以来，VEGF抑制剂迅速改变了湿性AMD的治疗方式和护理标准。雷珠单抗、贝伐单抗和阿柏西普是目前治疗湿性AMD最广泛使用的抗VEGF药物。本章讨论了这些药物的药理特性、药代动力学、安全性和疗效，并回顾了将这些药物确立为护理金标准的里程碑式临床试验。虽然这些药物极大地且积极地改变了我们治疗AMD的方式，但我们目前的治疗方案仍存在许多经济和治疗方面的局限性。在探索替代和新的治疗方式以及联合现有治疗选择以提高疗效、降低成本和减轻患者负担方面，仍不断有进展和创新。
