Treatment of dry age-related macular degeneration: A review

Age-related macular degeneration is a global disease with a significant societal impact. The advent of anti-vascular endothelial growth factor therapy (anti-VEGF) has revolutionised the treatment of neovascular age-related macular degeneration (nAMD). Dry age-related macular degeneration (dAMD) is being investigated for possible therapeutic options. The therapeutic categories undergoing clinical trials include complement pathway inhibitors, visual cycle modulators, reduction of toxic byproducts, antioxidative therapy, neuroprotective agents, laser therapy, surgical options, gene therapy, stem cell therapy, and miscellaneous treatments. Two intravitreal anti-complement factors (pegcetacoplan and avacincaptad pegol) have recently shown phase 3 clinical trial evidence of a reduction in the growth of geographic atrophy. In this review, we provide an update on treatment options currently undergoing clinical research trials for the management of dAMD and preventing the progression of Geographic Atrophy (GA).     

雷珠单抗治疗湿性AMD的研究进展

湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)是老年人群视力丧失的主要原因之一,目前其发病原因尚不明确.研究已证实血管内皮生长因子与湿性AMD有明确相关性,已有多种抗血管内皮生长因子的药物应用于其治疗.玻璃体腔注射雷珠单抗能抑制血管内皮生长因子,阻断新生血管生长及渗漏而发挥治疗作用,其在湿性AMD的治疗中已显示出确切疗效.本文对雷珠单抗治疗湿性AMD的进展作一综述,包括雷珠单抗治疗湿性AMD的方案及疗效,影响其疗效的因素,联合治疗,以及雷珠单抗治疗湿性AMD的不良反应等几个方面.     

Comparison of bevacizumab and ranibizumab in age-related macular degeneration:a systematic review and meta-analysis

AIM: To compare the effectiveness and safety between bevacizumab and ranibizumab in the treatment of age-related macular degeneration (AMD) through a systematic review and meta-analysis.METHODS:We performed a comprehensive search of randomized controlled trials (RCTs), non-RCTs, case-control and cohort studies that compared bevacizumab and ranibizumab using PubMed and the Cochrane Library. After the related data were extracted by two investigators independently, pooled weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects or a fixed-effects model.RESULTS:A total of four RCTs involving 1927 patients and eleven retrospective case series involving 2296 patients were included. For the primary outcomes, no significant differences were found between ranibizumab group and bevacizumab group in visual acuity (WMD:-0.04; 95%CI:-0.08 to 0.00; P=0.06), best corrected visual acuity (WMD:-0.05; 95%CI:-0.10 to 0.00; P=0.05), retina thickness (WMD:-4.69; 95%CI:-13.15 to 3.76; P=0.86) and foveal thickness (WMD:10.91; 95%CI:-14.73 to 36.56; P=0.40). The pooled analyses in the evaluation of safety showed that compared to bevacizumab, ranibizumab was associated with decreased risks of ocular inflammation (RR:0.45; 95% CI:0.23 to 0.89; P=0.02) and venous thrombotic events (RR:0.27; 95%CI:0.08 to 0.89; P=0.03). However, there were no significant differences observed in deaths (P=0.69) and arterial thromboembolic events (P=0.71) between the two groups.CONCLUSION:With equal clinical efficacy, ranibizumab was found to be associated with less adverse events compared to bevacizumab, indicating that ranibizumab might be a safer management.     

Bevacizumab versus ranibizumab for neovascular age-related macular degeneration:a Meta-analysis

AIM: To systematically compare the efficacy and safety of off-label bevacizumab versus licensed ranibizumab intravitreal injections as well as monthly regimen versus pro re nata [PRN (as needed)] regimen in the treatment of neovascular age-related macular degeneration (nAMD). METHODS: Relevant publications were identified through automatically retrieve of database and manually retrieving. The methodological quality of studies included was assessed using the Jadad score and the risk-of-bias assessment. The efficacy estimates were measured by the weight mean difference (WMD) for the improvement of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) reduction. The safety estimates were measured by odds ratios (OR) for adverse events rates. Statistical analysis was conducted by Revman 5.2.7. RESULTS: Seven studies were included in the Meta-analysis. There were no statistically significant differences between bevacizumab and ranibizumab in BCVA at 1 and 2y (P=0.37, P=0.18, respectively), However, both drugs has better BCVA given monthly than given as needed at 1 and 2y (P<0.05). The results demonstrated the mean decrease in CRT was less in bevacizumab group than ranibizumab group at 1y (P<0.05), while the difference was not significant at 2y (P=0.24). Treatment monthly gained much more decrease in CRT at 1 and 2y (P<0.005). There were no differences between drugs in the rates of death, arterial thrombotic events and venous thrombotic events (P=0.41, P=0.55, P=0.10, respectively), while the rates of medical dictionary for regulatory activities (MedDAR) system organ class events and ≥1 systemic serious adverse events were higher in bevacizumab group than ranibizumab group (P<0.05). But the incidences of death, arterial thrombotic events, venous thrombotic events, MedDAR system organ class events as well as ≥1 systemic serious adverse events were not statistically different between both treatment regimens of monthly and as needed (P=0.14, P=0.76, P=0.73, P=0.12, P=0.11, respectively). CONCLUSION: Bevacizumab was equivalent to ranibizumab for BCVA, however bevacizumab tended to gain less decrease in CRT and had higher rates of serious adverse events. Compared with treatment as needed, treatment monthly showed superior efficacy in BCVA improvement and CRT reduction, while the rates of adverse events were similar in the two dosing regimens.     

老年黄斑变性合并白内障患者行超声乳化术疗效分析

目的 探讨老年黄斑变性合并白内障患者行超声乳化手术联合人工晶状体植入的临床效果及安全性、可行性.方法 对40例52只眼老年黄斑变性合并白内障患者,行超声乳化联合人丁晶状体植入术,其中干性老年黄斑变性者45只眼,湿性老年黄斑变性者7只眼.收集其资料进行回顾性分析,观察患者术后视力改善情况及有无并发症发生.结果 术后3月时,90.38%患者视力不同程度提高,视力无明显提高甚至下降者5只眼,均为湿性黄斑变性患者.最佳矫正视力0.3-0.6者12只眼(其中达0.6者8只眼),0.1-0.3者35只眼,<0.1者5只眼.4例术中后囊破裂,3例术后角膜雾状水肿.术后1年,7只眼湿性黄斑变性均有不同程度的加重,干性黄斑变性患者未发现眼底新生血管之类改变.结论 超声乳化联合人工晶状体植入术可明显提高老年黄斑变性合并白内障患者术后视力,但对于湿性黄斑变性患者手术应慎重.     

眼底自发荧光技术在湿性年龄相关性黄斑变性诊断中的应用

湿性年龄相关性黄斑变性是年龄相关性黄斑变性的晚期阶段,可导致80％以上患者重度视力丧失,目前临床上诊断主要依靠相干光断层扫描和荧光素眼底血管造影等形态学检查手段,而眼底自发荧光(fundus autofluorescence,FAF)成像技术作为一种非侵入性检测手段,能反应脂褐质的分布及视网膜色素上皮层的活性,已逐渐成为湿性年龄相关性黄斑变性诊治中的观测指标之一.     

湿性年龄相关性黄斑变性患者注射雷珠单抗后早期眼压的变化

目的 观察湿性年龄相关性黄斑变性(wet age-related macular degenaration,wAMD）患者玻璃体腔注射雷珠单抗后早期眼压的变化。设计 前瞻性病例系列。研究对象 在北京医院接受玻璃体腔雷珠单抗（0.5mg/0.05ml）注射的wAMD患者135例（135眼）。方法 患者接受玻璃体腔注射雷珠单抗术前、术后10、30 min、2 h及术后1天,使用Topcon非接触眼压计分别测量眼压。观察患者注射后早期的眼压变化情况。主要指标 眼压。结果 患者术前眼压平均为（15.41±2.69） mmHg,术后10、30 min、2 h及术后1天的眼压平均值分别为（21.07±5.83） mmHg、（18.24±4.17） mmHg、（17.57±4.60） mmHg、（15.20±3.05） mmHg。术后2小时内的眼压与术前比有显著性差异（P均<0.05）,而术后1天眼压与术前比无显著性差异（P=0.239）。术后各时间段眼压升高比率呈逐渐下降趋势,其中术后10 min,眼压升高比率（眼压升高比率≥10 mmHg占17.78%;≥15 mmHg占5.19%）及升高绝对值（眼压≥21 mmHg占45.93%;≥25 mmHg占21.48 %;≥30 mmHg占8.15%）均明显高于其他时间段。术前眼压越高,术后10 min眼压≥21 mmHg的比例越高（P=0.000, OR=0.117, 95%CI=0.051-0.268）。结论 大部分湿性年龄相关性黄斑变性患者玻璃体腔注射雷珠单抗后早期眼压显著升高,2小时内眼压变化明显;术前眼压偏高可能是玻璃体腔注射雷珠单抗早期眼压升高的危险因素。     

Meta-analysis of the association of the HTRA1 polymorphisms with the risk of age-related macular degeneration

HTRA1 was considered as one of important age-related macular degeneration (AMD) candidate genes. However, due to population heterogeneity and bias from case-control study, the association between HTRA1 and AMD needs further confirmation across different studies in different population. In this study, a meta-analysis was performed in 14 case-control studies which were published before August 31, 2008. Effect of HTRA1 polymorphism with AMD was synthetically evaluated. The pooled odds ratio (OR) for heterozygous genotype GA versus wild homozygous genotype GG is 2.13 (95% CI: 1.90, 2.39), the OR of homozygous genotype AA versus GG is 6.92 (95% CI: 5.74, 8.34) and the OR of allele A carrier (GA + AA) versus GG is 3.02 (95% CI: 2.57, 3.53). Sub-analysis indicated that the risk of HTRA1 rs11200638 on wet AMD was stronger than dry AMD, and it seems that HTRA1 rs11200638 could increase the risk of AMD in all races. This study strengthens the hypothesis of association between rs11200638 in the promoter of HTRA1 polymorphism and AMD. The variant of HTRA1/625G → A could be a potentially promising genetic biomarker of AMD.     

Comparison of visual acuity outcomes between ranibizumab and bevacizumab treatment in neovascular age-related macular degeneration

AIM: To compare visual acuity (VA) outcomes between intravitreal injection of bevacizumab and ranibizumab in the treatment of neovascular age-related macular degeneration (AMD). METHODS: We conducted a consecutive, retrospective case series study in patients with newly diagnosed all type choroidal neovascularization (CNV) secondary to AMD who received an intravitreal injection of bevacizumab (1.25mg) or ranibizumab (0.3mg) at Lions Eye Institute, Western Australia from Mar. 2006 to May 2008. All patients received injection at baseline with additional monthly injections given at the discretion of the treating physician. Main outcome measures were changes in VA. RESULTS: There were 371 consecutive patients received injection at least in one eye with at least 6 months of follow up (median of 12.0 months). Bevacizumab treatment prevented 221 out of 278 (79.5%) patients from losing < 15 letters in VA compared with 79 out of 93 (84.9%) of ranibizumab treated patients (P=0.25). While 68 (24.5%) of bevacizumab treated patients gained ≥15 letters of VA compared with 24 (25.8%) of ranibizumab treated patients (P=0.79). 75.3% and 66.2% patients benefited from ranibizumab and bevacizumab respectively with final VA better than 6/60 (P=0.10). Multivariate analysis showed that pre-treatment VA was negatively associated with benefit outcome. Assignment of injection was not associated with VA outcome of benefit after adjusting the covariate (P=0.857). CONCLUSION: There are no difference in treatment efficacy in terms of VA between bevacizumab and ranibizumab in routine clinical condition.     

Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration

Currently available evidence on predictors of anti-vascular endothelial growth factor (VEGF) treatment response in neovascular age-related macular degeneration was reviewed. No meta-analysis of results is possible because of a lack of controlled and randomized trials, varying treatment regimes and outcome measures used, as well as suboptimal reporting. For genetic factors, most evidence to date has been generated for single nucleotide polymorphisms (SNPs) in the complement factor H (CFH), and VEGF-A genes. Just under half of the SNPs assessed in the CFH gene and 15% of the SNPs assessed in the VEGF gene were found to be associated with visual outcomes or the number of injections required during follow-up. Some evidence suggests association of worse treatment outcomes as well as a younger age at treatment onset with an increasing number of risk alleles in known risk genes (CFH and ARMS2/HTRA1) and polymorphisms in the VEGF-A gene. Clinical factors such as higher age, a better visual acuity (VA), a larger choroidal neovascularization (CNV) lesion at baseline, and a delay between symptom onset and initiation of treatment of more than 3 weeks also impact outcomes. Conversely, a worse acuity at baseline predicted more gain in vision. Overall, patients presenting with good acuity at baseline were more likely to have good VA at follow up, but the gain afforded by treatment was impacted by a ceiling effect. Most available evidence suggests a strong association of clinical factors such as age, baseline VA, and CNV lesion size with anti-VEGF treatment outcomes. No behavioral factors such as smoking influence treatment outcomes. Based on the studies conducted so far, the evidence suggests that underlying genotype of known AMD risk associated genes or of the VEGF-A gene have a limited effect, whereas presenting clinical factors appear to be more important in determining treatment outcomes.     

Influence of seasonal sunlight intensity and iris color on the anti-VEGF therapy for neovascular age-related macular degeneration

Purpose

To investigate the influence of seasonal light intensity and patients'' iris color on the visual recovery after anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD).

Methods

The visual acuity of 555 eyes (529 patients) with neovascular AMD was evaluated after intravitreal injections of either ranibizumab or bevacizumab in respect to global radiation intensity and iris color.

Results

The functional results during anti-VEGF therapy revealed a seasonal oscillation with a negative correlation between visual recovery and global radiation intensity (R²=−0.756, P=0.004). Although the influence of the sunlight intensity on the visual recovery was significant after the first injection, this effect vanished within the continuous course of treatment. Regarding the improvement of functional recovery depending on iris color, dark-colored eyes (16.0%) gained 8.5±10.0 letters after the first injection and 9.9±12.8 letters after the second injection, compared with 3.4±8.6 letters and 4.4±11.0 letters in light-colored eyes (84.0%), respectively (P=0.005 and P=0.019).

Conclusions

Our results indicate that seasonal sunlight intensity and iris color might influence the visual recovery of neovascular AMD patients undergoing anti-VEGF therapy. Our findings may be used as suggestions to refine individual anti-VEGF therapy regimens, especially in patients with light-colored eyes.     

6-weekly bevacizumab versus 4-weekly ranibizumab for neovascular age-related macular degeneration: a 2-year outcome

AIM: To compare visual acuity and central macular thickness (CMT) changes in neovascular age related macular degeneration patients treated with either 6 weekly bevacizumab regimen or 4 weekly ranibizumab on an as required basis. METHODS: Patients made an informed choice between bevacizumab 1.25 mg or ranibizumab 0.5 mg. The selected treatment was administered in the first 3 visits. Bevacizumab patients were followed-up 6 weekly and ranibizumab 4 weekly. Retreatment criteria was based on the reduction of >5 letters in the best-corrected visual acuity (BCVA), the presence of retinal fluid on optical coherence tomography (OCT) or new retinal haemorrhage. RESULTS: Visual acuity at 2y bevacizumab patients gained 7.0 letters and ranibizumab 9.2 (P=0.31, 95% CI -6.4 to 2.0). At 2y 86% of bevacizumab and 94% ranibizumab patients had not lost 15 letters or more (P=0.13). Mean CMT decreased at 2y bevacizumab by 146 µm, ranibizumab 160 µm (P=0.72). Mean number of injections was at 2y bevacizumzb 11.9, ranibizumab 10.3 (P=0.023). CONCLUSION: Bevacizumab 6 weekly on an as required basis was not demonstrably non-inferior to ranibizumab 4 weekly pro re nata (prn) in terms of BCVA and change in CMT. In the bevacizumab group, one more injection was required in the second year compared to the ranibizumab group.     

Intravitreal anti-VEGF monotherapy for thick submacular hemorrhage of less than 1 week duration secondary to neovascular age-related macular degeneration

Aim:

To investigate the role of anti-VEGF monotherapy in patients with thick submacular hemorrhage (SMH) of ≤1 week duration secondary to neovascular age-related macular degeneration (N-AMD).

Materials and Methods:

A retrospective chart review of 14 eyes of 14 patients presenting with acute decrease in central vision of ≤1 week duration secondary to a thick SMH measuring ≥ 2 MPS disk areas from N-AMD was performed. Intravitreal injections of bevacizumab 1.25 mg (13 eyes) or ranibizumab 0.5 mg (1 eye) were given monthly until resolution of SMH and less frequently thereafter, based on treat-and-extend approach utilizing spectral domain optical coherence tomography (SDOCT). Patients with follow-up of ≥6 months were included.

Results:

Patients presented after a median of 4 (range 1-7) days from the onset of SMH. Mean lesion size was 27.9 mm² (range 5.47-100, median 15), with blood comprising 77-98% of the lesion. Presenting visual acuity (VA) ranged from 20/60 to hand motions (median 20/200). Patients received a mean of 11.4 (range 5-20) injections over 18.4 (range 7-50) months. SMH resolved in all eyes in a mean of 4.8 (range 2-8) months. At 6 months follow-up, mean VA gain was −0.54 logMAR (range: −1.5 to +1, Snellen range 20/25-20/400, median 20/100, P = 0.0037), with 11 gaining ≥0.2 logMAR. Mean change in VA from baseline at final follow-up was −0.58 logMAR (range −1.6 to +1, Snellen range 20/30-20/400, median 20/60; P = 0.0022).

Conclusion:

A good anatomical and visual outcome can be accomplished in patients with thick SMH secondary to N-AMD treated with anti-VEGF monotherapy within 1 week.     

Influence of pigment epithelial detachment on visual acuity in neovascular age-related macular degeneration

Pigment epithelial detachment (PED), the anatomical separation of the retinal pigment epithelium from the Bruch membrane, is common in many chorioretinal diseases, including neovascular age-related macular degeneration. PED is present in about 30% to 80% of neovascular age-related macular degeneration patients based on the CATT, EXCITE, and VIEW studies. The influence of PED on visual acuity is controversial as a result of inconsistent results reported by various studies. With advances in imaging technologies, it is possible to evaluate not only the presence or absence of PED, but also detailed quantitative parameters, such as height, width, greatest linear diameter, area, volume, and reflectivity within the PED. We performed a comprehensive literature review to evaluate the relationship of PED with visual acuity. In summary, the presence or persistence of a PED may still be compatible with relatively good visual acuity. There is no strong evidence that the presence of a PED or aspects of its morphology has a significant impact on visual acuity. The presence of a PED may be predictive of the need for more regular treatment. More well-designed studies with standardized PED definitions and classifications are needed to evaluate the relationship between PED and visual acuity.     

湿性年龄相关性黄斑变性发病机制及治疗

湿性年龄相关性黄斑变性（AMD）是导致老年人视力受损甚至失明的重要原因,以黄斑区新生血管为主要病理特征,其发病与年龄、环境、遗传、氧化应激、脂质代谢、免疫机制等多因素相关。血管内皮生长因子（VEGF）已被证实是导致湿性AMD的重要因子。因此,抗VEGF药物是湿性AMD治疗领域中里程碑性的进展,但该治疗方法仍有诸多不足,如需要多次注射、部分患者对治疗应答欠佳甚至无应答、可能发生进行性纤维化等并发症。目前,许多新药正在被开发用来解决现有抗VEGF药物治疗的弊端。通过检索国内外相关文献及报道,我们对湿性AMD的分型、发病机制、治疗等的研究进展进行述评。     

雷珠单抗1+PRN和3+PRN治疗湿性年龄相关性黄斑变性的对比研究

目的　探讨雷珠单抗1+按需治疗方案（PRN）和3+PRN治疗湿性年龄相关性黄斑变性（AMD）的疗效和安全性。方法　前瞻性随机对照研究。选择2018年3月至2020年4月本院收治的152例（152眼）湿性AMD患者作为研究对象,采用随机数字表法将患者分为1+PRN组（77例77眼）和3+PRN组（75例75眼）。1+PRN组患者在基线治疗期（第0个月）玻璃体内注射雷珠单抗0.5 mg,在第1~12个月采用PRN;3+PRN组患者在核心治疗期（第0、1、2个月）给予玻璃体内注射0.5 mg雷珠单抗（共3次）,在延长治疗期采用PRN。统计随访期间两组患者最佳矫正视力（BCVA）、中心凹视网膜厚度（CMT）、平均病灶隆起最高点视网膜厚度（HLT）、平均病灶中央视网膜厚度（CLT）,进行视觉电生理检查,统计闪光视网膜电图（FERG）a波、b波潜时及波幅,记录图形视觉诱发电位（PVEP）P100波、闪光视觉诱发电位（FVEP）P100波的潜时及波幅;并统计两组患者的不良反应。结果　1+PRN组、3+PRN组患者核心治疗期内玻璃体内注药次数分别为（2.40±0.70）次、3.00次;随访12个月内注药次数分别为（6.22±2.01）次、（6.33±2.01）次,差异均无统计学意义（均为P>0.05）。与注药前相比,两组患者治疗后BCVA均显著升高（均为P<0.05）,两组患者不同时间点BCVA比较,差异均无统计学意义（均为P>0.05）。两组患者治疗后CMT、HLT、CLT均显著降低（均为P<0.05）,组间比较差异均无统计学意义（均为P>0.05）。两组患者治疗后FERG a波、b波及PVEP P100波的潜时均显著降低（均为P<0.05）,FERG a波、b波及PVEP P100波、FVEP P100波的波幅均显著升高（均为P<0.05）,两组比较差异均无统计学意义（均为P>0.05）。两组患者均未见严重全身及眼部不良反应。结论　雷珠单抗1+PRN及3+PRN治疗湿性AMD疗效相似,临床上可根据患者需求选择合适的治疗方案。     

Cost analysis comparing adjuvant epimacular brachytherapy with anti-VEGF monotherapy for the management of neovascular age-related macular degeneration

Aims

To consider the cost implication of adopting epimacular brachytherapy (EMB) for the treatment of neovascular (wet) age-related macular degeneration (wAMD), compared with ranibizumab or bevacizumab monotherapy.

Methods

This analysis compared the cumulative 3-year costs of anti-VEGF (vascular endothelial growth factor) monotherapy to EMB combined with anti-VEGF therapy. Two patient groups were considered: newly diagnosed (treatment-naïve) patients; and patients already receiving chronic anti-VEGF therapy.

Results

In the treatment-naïve patients, the highest cumulative treatment costs were associated with ranibizumab monotherapy (£25 658), followed by bevacizumab monotherapy (£16 177), EMB with ranibizumab (£14 002), then EMB with bevacizumab (£10 289). In previously treated patients, the highest treatment costs were ranibizumab monotherapy (£18 355), followed by EMB with ranibizumab (£17 428), bevacizumab monotherapy (£16 177), then EMB with bevacizumab (£12 129).

Conclusion

EMB combined with anti-VEGF treatment has the potential to yield considerable cost savings, compared with anti-VEGF monotherapy. If the ongoing large studies of EMB confirm the published feasibility data, then adjuvant EMB may represent a cost-effective alternative to anti-VEGF monotherapy.     

光动力疗法治疗老年黄斑变性临床初步观察

目的　观察应用光动力疗法 (photodynam ic therapy,PDT )单次治疗渗出型年龄相关性黄斑变性 (age- related m acu-lar degeneration,A MD )并发脉络膜新生血管 (choroidal neovascularization,CN V )的近期治疗效果。方法　以眼底检查、视力、眼底荧光血管造影 (FFA)、吲哚青绿脉络膜血管造影 (ICG)和光学相干断层成像技术 (O CT)等影像学检查为观察指标 ,总结PDT治疗 15例 16眼 A MD合并的典型 CNV后 1周和 1个月随访的短期治疗效果 ,从而评价 PDT治疗 CNV的安全性和短期治疗效果。结果　治疗后 1周和 1个月分别有 6眼和 10眼视力不同程度提高 ,1眼因新出血视力略有下降 ,无证据表明与治疗有关。 15例 16眼治疗后荧光渗漏均有不同程度的减弱或消退 ,其中 7例 8眼渗漏完全消退 ,1月后复查无复发 ;其余 8例8眼荧光渗漏明显减轻。全部 15例治疗过程中未发生任何不良反应 ;仅 3例治疗后主述有一过性轻度视力紊乱。结论　光动力疗法单次治疗渗出型年龄相关性黄斑部变性并发的脉络膜新生血管膜短期疗效满意、安全 ,对视力无损害。     

玻璃体腔内注射Bevacizumab治疗湿性年龄相关性黄斑变性的临床应用

湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)是以黄斑区出现脉络膜新生血管膜(choroidal neovascularization,CNV)为特点,血管内皮生长因子(vascular endothelial growth factor,VEGF)是目前已知促新生血管形成最主要的刺激因子,VEGF抑制剂通过拮抗作用,抑制血管生成、降低血管通透性,促进CNV渗液的吸收.Bevacizumab虽然存在药物标识外使用(off-label)问题,它对湿性AMD仍以相对好的短期治疗效果和低廉的治疗成本在国际眼科界被广泛应用.玻璃体腔内1个月注射1次Bevacizumab(1.25 mg),连续注射3次的方案优于注射1次后再根据病情再次注射的方案.治疗后湿性AMD患者眼底解剖结构和视力均有明显改善.