Antiangiogenic Approaches to Age-Related Macular Degeneration Today
Antiangiogenic Approaches to Age-Related Macular Degeneration Today
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DOI：
10.1016/j.ophtha.2009.06.048
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发表时间：
2009-10-01
期刊：
影响因子：
13.7
通讯作者：
Bressler, Neil M.
中科院分区：
文献类型：
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作者：
Bressler, Neil M.
对于年龄相关性黄斑变性（AMD）中黄斑中心凹下脉络膜新生血管（CNV）的特定病例，与不治疗或光动力治疗相比，玻璃体内注射雷珠单抗可降低视力丧失的风险并增加视力增加的机会。尽管玻璃体内注射雷珠单抗在 MARINA（抗 VEGF 抗体雷珠单抗治疗新生血管性 AMD 的最小经典/神秘试验）或 ANCHOR（抗 VEGF 抗体用于治疗 AMD 中主要经典脉络膜新血管形成）试验中治疗的大多数病例中没有带来实质性改善（ETDR 图表上有 15 个或更多字母），但少数病例出现了严重的视力丧失。眼内炎是已知最严重的治疗风险，虽然罕见，但始终存在可能性。当由于监管或财务限制而无法获得雷珠单抗时，可以考虑玻璃体内注射贝伐单抗；如果非劣效性试验显示贝伐单抗几乎与雷珠单抗一样好或优于雷珠单抗，即使没有财务限制，也可以考虑用玻璃体内贝伐单抗代替雷珠单抗。玻璃体内注射雷珠单抗或贝伐珠单抗的系统风险尚不清楚，尽管试验已排除雷珠单抗的中度或大系统风险。当荧光素血管造影 (FA) 上的病变成分主要为经典时，或当推测近期疾病进展且病变成分为最低程度的经典或隐匿性但无经典时，在开始治疗中心凹下且主要为 CNV 的病变时，应考虑这种治疗。光学相干断层扫描、FA 或两者都可能有助于在开始治疗后做出有关继续治疗的决定。然而，迄今为止，几乎没有一致的信息表明，利用这些成像方式考虑在 2 年前停止治疗已被证明可以产生与每月治疗一样好的结果。在考虑治疗不以 CNV 为主的中心凹下 CNV 时，例如以血液病变为主或以疤痕为主的病变，以及与视力水平极低相关的病变或由 AMD 以外的原因引起的病变时，应谨慎推断这些建议。本系列的后续评论讨论了未来考虑的其他 CNV 疗法。 财务披露：专有或商业披露可能会在 CME 的前沿问题中找到。眼科 2009；116：S15-S23 (C) 2009 美国眼科学会。
Intravitreal ranibizumab reduces the risk of visual acuity loss and increases the chance of visual acuity gain compared with no treatment or photodynamic therapy for selected cases of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Although intravitreal ranibizumab did not result in substantial improvement (15 or more letters on an ETDRs chart) in the majority of cases treated in the MARINA (Minimally classic/occult trial of the Anti-VEGF antibody Ranibizumab in the treatment of Neovascular AMD) or ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic CHORoidal Neovascularization in AMD) trials, few cases experienced substantial visual acuity loss. The most serious known risk of treatment, endophthalmitis, although rare, is always a possibility. Intravitreal bevacizumab might be considered when ranibizumab is not available because of regulatory or financial constraints, and it might be considered in place of ranibizumab even without financial constraints if noninferiority trials show that bevacizumab is almost as good as-or is better than-ranibizumab. Systemic risks of intravitreal ranibizumab or bevacizumab are unknown, although trials have ruled out moderate or large systemic risks for ranibizumab. This therapy should be considered when initiating therapy for lesions that are subfoveal, and predominantly CNV when the lesion composition on fluorescein angiography (FA) is predominantly classic, or when there is presumed recent disease progression and the lesion composition is minimally classic or occult with no classic. Optical coherence tomography, FA, or both also might be of value to assist with decisions regarding continuation of treatment after it has been initiated. However, to date, there is little consistent information to suggest that utilizing these imaging modalities to consider withholding treatment before 2 years has been shown confidently to result in outcomes as good as monthly treatment. Extrapolation of these recommendations should be done with caution when considering the treatment of subfoveal CNV that is not predominantly CNV, such as predominantly blood lesions or lesions that are predominantly scar, as well as lesions associated with very low levels of visual acuity or those owing to causes other than AMD. A subsequent review in this series discusses other therapies for CNV being considered in the future.Financial Disclosure(s): Proprietary or commercial disclosure may be found in the CME frontmatter. Ophthalmology 2009;116:S15-S23 (C) 2009 by the American Academy of Ophthalmology.