Wet age related macular degeneration management and follow-up
Wet age related macular degeneration management and follow-up
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发表时间：
2016
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通讯作者：
Malciolu Radu Alexandru;Nica Maria Alexandra
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作者：
Malciolu Radu Alexandru;Nica Maria Alexandra
视网膜相关性黄斑变性（AMD）被认为是发达国家不可逆视力丧失的主要原因，对生活质量产生深远影响。AMD的新生血管形式的特征在于视网膜下脉络膜新生血管形成，导致突然和严重的视力丧失。研究已经确定血管内皮生长因子（VEGF）是新生血管性AMD中的重要病理生理组分，并且其眼内抑制是医学上最有效的疗法之一。抗VEGF作为湿性AMD的标准治疗的引入已经导致患者预后的极大改善，使得在绝大多数情况下恢复和维持视觉功能。然而，由于患者数量的增加、每月评估的压力以及相关的经济负担，治疗益处伴随着维持治疗方案的困难。因此，治疗策略已从每月固定给药发展到个体化方案，旨在获得可比的结果，但注射次数较少。其中一个协议被称为“pro re nata”，或“治疗和观察”。给予患者3个月注射的负荷剂量，然后根据视敏度的恶化、眼底镜检查中疾病活动的临床证据或在视网膜内或视网膜下液体存在下视网膜增厚的OCT证据，根据需要决定治疗。另一种不同的方案被称为“治疗和延长”，一旦疾病稳定，注射之间的间隔就会逐渐增加。本文旨在综述目前可用的抗VEGF药物-贝伐单抗，雷珠单抗，阿柏西普，以及上述治疗策略。
Age-related macular degeneration (AMD) is referred to as the leading cause of irreversible visual loss in developed countries, with a profound effect on the quality of life. The neovascular form of AMD is characterized by the formation of subretinal choroidal neovascularization, leading to sudden and severe visual loss. Research has identified the vascular endothelial growth factor (VEGF) as an important pathophysiological component in neovascular AMD and its intraocular inhibition as one of the most efficient therapies in medicine. The introduction of anti-VEGF as a standard treatment in wet AMD has led to a great improvement in the prognosis of patients, allowing recovery and maintenance of visual function in the vast majority of cases. However, the therapeutic benefit is accompanied by a difficulty in maintaining the treatment schedule due to the increase in the amount of patients, stress of monthly assessments, as well as the associated economic burden. Therefore, treatment strategies have evolved from fixed monthly dosing, to individualized regimens, aiming for comparable results, with fewer injections. One such protocol is called “pro re nata”, or “treat and observe”. Patients are given a loading dose of 3 monthly injections, followed by an as-needed decision to treat, based on the worsening of visual acuity, clinical evidence of the disease activity on fundoscopy, or OCT evidence of retinal thickening in the presence of intra or subretinal fluid. A different regimen is called “treat and extend”, in which the interval between injections is gradually increased, once the disease stabilization is achieved. This paper aims to review the currently available anti- VEGF agents – bevacizumab, ranibizumab, aflibercept, and the aforementioned treatment strategies.