Recent advances in the management of dry age-related macular degeneration: A review.
Recent advances in the management of dry age-related macular degeneration: A review.
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DOI：
10.12688/f1000research.10664.1
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Querques G
中科院分区：
文献类型：
--
作者：
Bandello F;Sacconi R;Querques L;Corbelli E;Cicinelli MV;Querques G
视网膜相关性黄斑变性（AMD）是导致老年人视力丧失的最重要原因，是一种具有多因素发病机制的中央视网膜退行性疾病。根据脉络膜新血管形成的存在，AMD被分类为干性AMD（d-AMD）或新血管性AMD。目前，没有治疗被批准用于地图状萎缩，d-AMD的晚期形式，因为没有治疗可以恢复视网膜色素上皮（RPE）或光感受器的损伤。因此，d-AMD的所有治疗方法都可能预防和减缓现有萎缩的进展。本文综述了d-AMD的管理，特别是在临床试验中评估的潜在治疗目标的当前数据。 临床上有许多检查可用于监测d-AMD患者的视网膜、RPE和脉络膜的形态学变化。眼底自发荧光和光学相干断层扫描（OCT）被认为是诊断和随访d-AMD改变的最有用的工具，包括监测萎缩区域进展。相反，OCT血管造影术是一种新的成像工具，可以增加受d-AMD影响的患者的进一步信息。 包括氧化应激、脂褐素沉积、慢性炎症和脉络膜血流不足在内的几种途径似乎在d-AMD的发病机制中起重要作用，并代表了新疗法的可能靶点。大量的治疗d-AMD正在调查与有希望的结果在初步研究。然而，只有少数这些药物将进入市场，为受干性AMD影响的患者提供治疗机会，并帮助他们保持良好的视力。进一步的长期随访研究对于检验正在研究的药物的真实的安全性和有效性是很重要的。
Age-related macular degeneration (AMD), the most important cause of vision loss in elderly people, is a degenerative disorder of the central retina with a multifactorial etiopathology. AMD is classified in dry AMD (d-AMD) or neovascular AMD depending on the presence of choroidal neovascularization. Currently, no therapy is approved for geographic atrophy, the late form of d-AMD, because no treatment can restore the damage of retinal pigment epithelium (RPE) or photoreceptors. For this reason, all treatment approaches in d-AMD are only likely to prevent and slow down the progression of existing atrophy. This review focuses on the management of d-AMD and especially on current data about potential targets for therapies evaluated in clinical trials. Numerous examinations are available in clinics to monitor morphological changes in the retina, RPE and choroid of d-AMD patients. Fundus autofluorescence and optical coherence tomography (OCT) are considered the most useful tools in the diagnosis and follow-up of d-AMD alterations, including the monitoring of atrophy area progression. Instead, OCT-angiography is a novel imaging tool that may add further information in patients affected by d-AMD. Several pathways, including oxidative stress, deposits of lipofuscin, chronic inflammation and choroidal blood flow insufficiency, seem to play an important role in the pathogenesis of d-AMD and represent possible targets for new therapies. A great number of treatments for d-AMD are under investigation with promising results in preliminary studies. However, only few of these drugs will enter the market, offering a therapeutic chance to patients affected by the dry form of AMD and help them to preserve a good visual acuity. Further studies with a long-term follow-up would be important to test the real safety and efficacy of drugs under investigation.