Management of neovascular age-related macular degeneration
Management of neovascular age-related macular degeneration
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DOI：
10.1016/j.preteyeres.2007.03.002
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发表时间：
2007-07-01
影响因子：
17.8
通讯作者：
Pruente, Christian
中科院分区：
文献类型：
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作者：
Schmidt-Erfurth, Ursula M.;Pruente, Christian
随着老年人口比例的不断增加，新生血管性老年性黄斑变性(AMD)正成为一个日益严重的社会医学问题。然而，对疾病发病机制的新见解为开发比以往任何时候都更成功地攻击疾病过程的靶向治疗提供了机会。这篇综述文章将重点总结新生血管性AMD的实际治疗方案，并简要概述最近临床和临床前评估的治疗方案。最近用于临床常规的抗血管内皮生长因子物质的进展显著改善了新生血管性AMD患者的预后。在AMD治疗的历史上，第一次使用针对所有同种血管内皮生长因子(VEGF)的物质进行玻璃体内治疗，导致新生血管性AMD患者的视力显著提高。总体而言，抗血管生成方法在90%以上的患者中提供了视力维持，在25%-40%的患者中提供了实质性的改善。与光动力疗法(PDT)等闭塞疗法相结合，可能会减少再次治疗的频率，并长期保持治疗效益。与血管生成级联反应的各个步骤相互作用的进一步发展正在临床或临床前评估中，可能很快就会出现。然而，越来越多的新治疗方案将不得不在随机对照临床试验中提供概念证据，鉴于该领域的快速发展，这是一个重大挑战。对于那些已经在临床上使用的疗法，需要开发合理的诊断工具进行后续治疗，因为对所有患者和所有适应症进行持续临床监测的负担对患者和医生来说都是沉重的。最终，经济问题将成为不同治疗方案临床可获得性的限制因素。(C)2007爱思唯尔有限公司。保留所有权利。
Neovascular age-related macular degeneration (AMD) is becoming an increasing socio-medical problem as the proportion of the aged population is continuously increasing. However, new insights in the pathogenesis of the disease offer the opportunity to develop targeted therapies that attack the disease process more successfully than ever.This review article will focus on summarizing the actual options in the management of neovascular AMD and provide a short overview about recent therapeutic options in clinical and preclinical evaluation.The recent development of anti-VEGF substances for use in clinical routine has markedly improved the prognosis of patients with neovascular AMD. Intravitreal treatment with substances targeting all isotypes of vascular endothelial growth factor (VEGF), for the first time in the history of AMD treatments, results in a significant increase in visual acuity in patients with neovascular AMD. Overall, anti-angiogenic approaches provide vision maintenance in over 90% and substantial improvement in 25-40% of patients. The combination with occlusive therapies like photodynamic therapy (PDT) potentially offers a reduction of re-treatment frequency and long-term maintenance of the treatment benefit. Further developments interacting with various steps in the angiogenic cascade are under clinical or preclinical evaluation and may soon become available.Nevertheless, the growing number of novel therapeutic options will have to provide proof of concept in randomized controlled clinical trials, a major challenge in view of the rapidly evolving field. For those therapies, which are already in clinical use, reasonable diagnostic tools for follow-up need to be developed, as the burden of continuous clinical monitoring of all patients and all indications is significant for patients and doctors. Ultimately, economic issues will be the limiting factor for the clinical availability of different treatment options. (c) 2007 Elsevier Ltd. All rights reserved.