年龄相关性黄斑变性的临床治疗与预防探讨

年龄相关性黄斑变性（age-related maeular degeneration,ARMD）患者多为50岁以上,双眼先后或同时发病,视力呈进行性损害。该病是60岁以上老人视力不可逆性损害的首要原因,发病率随年龄增加而增高。确切病因尚未明了,可能与遗传因素、黄斑长期慢性光损伤、代谢及营养因素等有关。本文旨在探讨年龄相关性黄斑变性的临床治疗与预防,现报告如下。     

中药配方治疗年龄相关性黄斑变性

目的观察光明亮睛散治疗年龄相关性黄斑变性的疗效。方法确诊为年龄相关性黄斑变性患者60例82只眼,采用专病专方治疗,观察治疗前后对患者的视力、眼底照相、荧光素眼底血管造影检查情况。结果显效12眼,有效43眼,无效27眼,总有效率67%。结论应用光明亮睛散治疗年龄相关性黄斑变性有较好的效果,可显著提高视功能。     

年龄相关性黄斑变性治疗药物的研究进展

随着我国人口的日益老龄化,年龄相关性黄斑变性(AMD)正成为老年人的主要致盲眼病。目前,AMD的治疗方法有多种,其中药物治疗正越来越受到人们的关注。本文就一些已证明有效的药物,包括曲安奈德、哌加他尼钠、兰尼单抗、阿奈可他、贝伐单抗、角鲨胺等的研究现状作一介绍。     

年龄相关性黄斑变性治疗药

1商品名 Macugen 2开发与上市厂商 本品由Gilead Sciences公司研制。2005年1月在美国首次上市。     

湿性年龄相关性黄斑变性和糖尿病性黄斑水肿治疗新药—Faricimab

Faricimab是血管生成素-2(Ang-2)和抗血管内皮生长因子(VEGF)的双靶向抑制药。2022年1月,FDA批准faricimab注射剂通过玻璃体内注射使用治疗新生血管(湿性)年龄相关性黄斑变性(nAMD)和糖尿病性黄斑水肿(DME)。研究显示,faricimab的给药间隔可以最多延长到16周。最常见的药物不良反应为结膜出血。本文对faricimab的药理作用、药代动力学、临床评价、安全性及用法用量方面进行综述,旨在为临床合理用药提供参考。     

年龄相关性黄斑变性的药物治疗

目前,年龄相关性黄斑变性的患病率和发病率均逐年上升,是发达国家老年人主要致盲眼病。近年来,其预防性治疗以抗氧化为主,药物治疗以抗脉络膜新生血管(CNV)为主,而抗CNV的重心也已由激光治疗转为从转录及表达水平针对血管内皮生长因子及其受体的治疗。该文就目前临床上药物治疗年龄相关性黄斑变性的现状和新药物、新方向进行综述,以期对年龄相关性黄斑变性的治疗指明方向。     

年龄相关性黄斑变性——致盲第一“杀手”

年龄相关性黄斑变性（AMD）又称老年性黄斑变性，是一种随年龄增长而发展的多因素致盲性疾病。     

高血压和视网膜动脉硬化与年龄相关性黄斑变性调查

目的 研究高血压、视网膜动脉硬化与年龄相关性黄斑变性发病的相关性.方法 前瞻性系列病例研究.收集296名体检患者的临床资料,包括全身和眼部的诊治详情.按性别不同,分别统计高血压、视网膜动脉硬化、年龄相关性黄斑变性的发病率,分析高血压、视网膜动脉硬化与年龄相关性黄斑变性之间的相关性.结果 高血压患者中并发年龄相关性黄斑变性的发病率明显高于血压正常人年龄相关性黄斑变性的发病率(x2=15.72,P＜ 0.01);视网膜动脉硬化患者中年龄相关性黄斑变性的发病率也显著高于无视网膜动脉硬化者的年龄相关性黄斑变性的发病率(x2=23.74,P＜0.01),两组对照相比差异有统计学意义.高血压的程度与年龄相关性黄斑变性的发病率呈正相关关系(F=0.743,P＜0.05).结论 高血压、视网膜动脉硬化与年龄相关性黄斑变性三者之间关联紧密,高血压、视网膜动脉硬化可能是年龄相关性黄斑变性发病的危险因素之一.     

血流变指标与年龄相关性黄斑变性关系

目的：分析血流变指标与年龄相关性黄斑变性的关系。方法对120例确诊年龄相关性黄斑变性患者为病例组,与115例非年龄相关性黄斑变性患者为对照组的血流切变率及血浆浓度进行比较分析。结果年龄相关性黄斑变性患者血流切变率（VS）1 K．00、血流切变率（VS）5．00和血浆粘度与年龄相关性黄斑变性的联系差异有统计学意义（ P ＜0．05）。结论血流切变率（VS）1．00、血流切变率（VS）5．00和血浆浓度指标升高,年龄相关性黄斑变性危险性增大。     

State-of-the art pharmacotherapy for non-neovascular age-related macular degeneration

ABSTRACT

Introduction

Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the industrialized world. While effective treatment is available for neovascular AMD, no therapy is successful for the non-neovascular form. Herein, the authors report the current knowledge on non-neovascular AMD pathogenesis and the promising research on treatments.     

An epidemiological study of neovascular age-related macular degeneration in Germany

Abstract

Objective:

Neovascular or wet age-related macular degeneration (AMD) is one of the leading causes of blindness in industrialized countries; however, there is a lack of recent epidemiological data from Germany. The aim of this study was to collect epidemiological data from patients in Germany with suspected neovascular AMD and evaluate the diagnostic procedures performed and treatments used at clinics.     

Current advances in the treatment of neovascular age-related macular degeneration

Introduction: Age-related macular degeneration (AMD) is the most common cause of permanent central visual acuity loss in persons over 65 years of age in industrialized nations. Today, intravitreal vascular endothelial growth factor (VEGF) inhibitors are the mainstay of treatment worldwide.

Areas covered: The following review covers the current treatments and challenges of wet AMD management. It also covers emerging therapies including radiation, latest generation anti-VEGF agents, and combination therapies.

Expert opinion: Current neovascular AMD therapy is aimed at decreasing the VEGF effect at the choroidal neovascularization (CNV) complex. The most important existing challenges in the treatment of neovascular AMD are improving visual outcomes, decreasing the treatment burden, and minimizing geographic atrophy. Clinicians are using many treatment strategies to minimize intravitreal injections without sacrificing visual outcomes. Combination of anti-VEGF therapy with other previously available treatments that target a different pathophysiological mechanism may be a reasonable clinical strategy to minimize intravitreal injections. Many exciting novel drugs that target newly discovered pathways associated with CNV development and progression hold clinical promise. The results of ongoing randomized clinical trials will answer the important concerns surrounding new drugs and delivery devices: safety and visual outcomes.     

A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: comparison of ranibizumab and bevacizumab

Abstract

Objective:

To systematically review ocular and systemic events in treatment of wet age-related macular degeneration (AMD) with anti-vascular endothelial growth factor antibodies, ranibizumab and bevacizumab, and to provide a detailed perspective of their differences on clinical use, efficacy and safety.     

The association of smokeless tobacco use and pack-years of smokeless tobacco with age-related macular degeneration in Indian population

Aim: To explore the association of use versus no use and the influence of pack-year use of smokeless tobacco with that of early and late age-related macular degeneration (AMD) in rural and urban south Indian population. We hypothesized that the use and pack-years of use would be significantly associated with both early and late AMD. We therefore sought to examine subjects who gave a history of using smokeless tobacco and we quantified the usage as pack-years, to examine the association with that of early and late AMD.

Materials and methods: This was part of Sankara Nethralaya: Rural–Urban Age-related Macular degeneration study (SN-RAM study), which was conducted between 2007 and 2010. Subjects aged 60 years or older or those turning 60 in the present calendar year, with a history of using smokeless tobacco were noted along with duration and number of packs used per day. Smokeless tobacco was defined as chewed-tobacco (loose leaves) and/or snuff (finely chopped tobacco). Subjects underwent detailed ophthalmic evaluation including cataract grading using the Lens Opacities Classification System (LOCS III), 45° 4-field stereoscopic fundus photography and AMD evaluation. Pack-years of smokeless tobacco use was stratified as <15, 15–34 and ≥35 years; the association of tobacco use and pack-years of use with that of early and late AMD was examined. A p value of Results: The number of smokeless tobacco users was significantly higher in rural (n?=?767) than in urban groups (n?=?281), p?p?=?0.756 or that between AMD and no AMD, p?=?0.562. Use of smokeless tobacco compared with no use was significantly associated with late AMD, OR=?3.178, 95%CI: 1.095, 9.227, p?=?0.033, when adjusted for age, gender, rural-urban differences, presence of diabetes, socioeconomic status, systolic and diastolic blood pressure, total cholesterol, low-density and high-density lipoprotein levels. The association was not significant for early AMD, p?=?0.582. The pack-years of use did not show a statistically significant association with early or late AMD. Furthermore, out of the 1048 subjects, 547 reported as using areca nut. Of which, 415 (75.8%) subjects had no AMD, 119 (21.7%) showed evidence of early AMD and 13 (2.4%) had late AMD. There was no significant association between the use of areca nut and early AMD, (X² (1, N?=?930)?=?2.345, p?=?0.126) or with that of late AMD (X² (1, N?=?761)?=?0.075, p?=?0.785).

Conclusions: Smokeless tobacco use compared with no use, is associated with late AMD, regardless of the pack-years of use. Tobacco use is a modifiable risk factor. Efforts to reduce or stop the use of smokeless tobacco is indicated in an effort to prevent vision loss with respect to late AMD.     

白内障摘除术患者术后5年老年性黄斑变性发病情况研究

目的 研究白内障摘除术患者术后5年手术眼与对侧眼老年性黄斑变性(AMD)发病情况.方法 选取2004-2006年在仙居县人民医住院行单眼白内障摘除术的患者221例,随访60个月以上,比较患者手术眼与对侧眼AMD发病情况.结果 共有132例完成随访,随访率为59.70％.白内障摘除术后3个月患者脱残率为80.30％ (106/132),脱盲率为99.20％ (131/132).术后5年手术眼AMD总发病22例(16.67％),对侧眼总发病20例(15.15％),差异无统计学意义(x2 =0.11,P＞0.05).其中轻度AMD的OR值为1.092,95％ CI 0.479～2.492;中度AMD的OR值为1.187,95％ CI 0.387～3.644;重度AMD的OR值为1.188,95％ CI 0.387～3.647;总AMD的OR值为1.120,95％ CI 0.579 ～2.167.结论 白内障摘除术患者术后5年手术眼与对侧眼AMD发病情况差异无统计学意义,白内障摘除术不是患者术后5年AMD发病的危险因素.     

Investigation of vascular endothelial dysfunction in the patients with age-related macular degeneration

Purpose: This study aims to evaluate the association between age-related macular degeneration (AMD) and cardiovascular disease by using the noninvasive flow-mediated dilation (FMD) test to show endothelial dysfunction as an indicator of subclinical atherosclerosis.

Method: Participants in this study included 30?dry AMD patients, 30 wet AMD patients, and 30 healthy controls without any systemic disease, including AMD. FMD and the intima media thickness (IMT) of the carotid artery were compared between the groups.

Results: Comparison of FMD between the groups showed a 10.96% brachial artery dilation in the healthy controls, 3.99% in the dry AMD group, and 5.03% in the wet AMD group. While a significant difference was not observed between the wet and dry AMD groups, comparison of the control group to the wet and dry AMD groups yielded a significant difference. When brachial artery dilation below 7% was accepted as an abnormal FMD, 26.7% of the healthy controls, 66.7% of the dry AMD patients and 76.7% of the wet AMD patients were found to be abnormal. Similarly, while no significant difference was observed between the wet and dry AMD groups, comparison of the control group with the wet and dry AMD patients yielded a significant difference. When an IMT below 0.7?mm was accepted as abnormal, 26.7% of the healthy controls, 33.3% of the dry AMD, and 43.3% of the wet AMD were found to have an abnormal IMT. However, differences between the groups did not reach statistical significance.

Conclusions: In this study, use of the FMD test showed endothelial dysfunction among AMD patients. No significant differences were found between the dry and wet AMD patient groups.     

Anti-VEGF agents for age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of legal blindness in the elderly in the industrialized world and the third major cause of blindness around the globe. Although neovascular AMD is less prevalent than atrophic AMD, it accounts for most cases with severe visual loss from AMD. VEGF seems to be a key contributary factor in the pathophysiology underlying neovascular AMD. Until recently, treatment options for neovascular AMD were limited. With the recent development of anti-VEGF therapies that have demonstrated efficacy in studies with broad eligibility criteria, the repertoire of treatments for neovascular AMD has been significantly expanded to now include the various recognized angiographic lesion subtypes. To discuss recent anti-VEGF agents in the management of AMD. Although therapy with anti-VEGF agents is the gold standard with promising results, many intravitreal injections are often required, and they do not cure all cases of wet AMD. With the recent advances in the medical therapy of exudative AMD, there is reason to be optimistic about future management of AMD as well.