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在美国等发达国家中,老年黄斑变性(AMD)是65岁以上人群最主要的致盲原因。迄今为止,老年黄斑变性的治疗方法很有限。目前的治疗方法可以分为两大类:物理治疗和药物治疗。前者曾受到广泛关注却效果不显著,而后者近来发展迅速。药物治疗包括:光动力学治疗、激素、血管内皮生长因子VEGF的抑制药物、细胞外间质的修饰药物、基因治疗、营养补充和脉络膜血流促进药物等。光动力学治疗是某些特定类型的新生血管型AMD唯一有效的治疗方法。Anecortaveacetate(一种人工合成的激素)球旁注射可以稳定患者的视力达6mo。玻璃体腔注射VEGF的拮抗药物,也能稳定患者的视力3mo。在AMD的早期就可发现脉络膜血流的改变。血管压力的增加是AMD重要的血流动力学改变,它导致了脉络膜毛细血管血流减少。经过一系列反应,最终导致视网膜色素上皮细胞变性、Bruch膜断裂、脉络膜新生血管形成、老年黄斑变性、失明。因此改善脉络膜血流的药物可能阻止AMD的发展和恶化。虽然这些药物还多处于试验阶段,但还是很有希望来发现治疗AMD的药物,从而阻止其发展。
In developed countries such as the United States, age-related macular degeneration (AMD) is the leading cause of blindness among people over 65 years of age. To date, there are limited treatments for age-related macular degeneration. The current treatment methods can be divided into two categories: physical therapy and medical treatment. The former has received widespread attention but its effect is not significant, while the latter has been developing rapidly. Drug therapy includes: photodynamic therapy, hormones, vascular endothelial growth factor VEGF inhibitory drugs, extracellular matrix modified drugs, gene therapy, nutritional supplements and choroidal blood flow promoting drugs. Photodynamic therapy is the only effective treatment for certain types of neovascular AMD. Anecortaveacetate (a synthetic hormone) injection of the ball can stabilize the patient’s visual acuity of 6mo. Intravitreal injection of VEGF antagonist drugs, but also to stabilize the patient’s visual acuity 3mo. Choroidal blood flow changes can be detected early in AMD. Increased vascular pressure is an important hemodynamic change in AMD, which leads to a decrease in choroidal capillary blood flow. After a series of reactions, eventually lead to degeneration of retinal pigment epithelium, Bruch’s membrane rupture, choroidal neovascularization, age-related macular degeneration, blindness. Therefore, drugs that improve choroidal blood flow may prevent the development and worsening of AMD. While many of these drugs are still in the experimental phase, there is great promise for discovering drugs for the treatment of AMD, preventing their development.