PDF(Pubmed)
Abstract：
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness worldwide and a severe medical and social problem. The steadily increasing number of patients is related to the aging of the population. So far, many factors affecting the development of AMD have been identified, which can be divided into non-modifiable, including genetic factors, age, and sex, and modifiable or environmental factors, such as smoking, poor diet, and hypertension. Early stages of age-related macular degeneration are characterized by fundus drusen and abnormalities in the retinal pigment epithelium. In late stages, geographic atrophy and choroidal neovascularization (CNV) are observed. The treatment of AMD, especially its advanced forms, is very challenging. Intensive research has made it possible to treat advanced stages of the dry form of AMD with pegcetacoplan and avacincaptad pegol, new drugs approved for use in the US. Pegcetacoplan targets the C3 and avacincaptad pegol targets the C5, the pivotal proteins of the complement cascade. The drugs are administered by intravitreal injection. The gold standard for neovascular AMD (nAMD) consists of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs such as bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab. Treatment can be administered according to the fixed, pro-re-nata, and treat-and-extend regimens. The latter seems to have the best effect on improving visual acuity (VA) and the maximum therapeutic benefit. The search continues for the best ways to deliver intravitreal drugs. Current methods include sustained-release implants and hydrogel platforms for drug release, while the most promising future pathways for treating dry and nAMD are stem cell and gene therapy.
摘要：
年龄相关性黄斑变性（AMD）是全球范围内不可逆失明的主要原因，也是严重的医学和社会问题。患者数量的稳步增加与人口老龄化有关。到目前为止,已经确定了许多影响AMD发展的因素，可以分为不可修改的，包括遗传因素,年龄,和性,和可改变的或环境因素，比如吸烟，不良饮食,和高血压。年龄相关性黄斑变性的早期阶段的特征是眼底玻璃疣和视网膜色素上皮异常。在后期阶段,观察到地理萎缩和脉络膜新生血管(CNV)。AMD的治疗，尤其是它的先进形式，非常具有挑战性。深入研究使pegcetacoplan和avacincaptadpegol治疗干性AMD的晚期成为可能，美国批准使用的新药。Pegcetacoplan靶向C3，avacincaptadpegol靶向C5，补体级联的关键蛋白。药物通过玻璃体内注射施用。新生血管性AMD（nAMD）的金标准包括玻璃体内注射抗血管内皮生长因子（抗VEGF）药物，如贝伐单抗，雷珠单抗,aflibercept,brolucizumab,和法利玛。治疗可按固定的方式进行，支持纳塔,治疗和扩展方案。后者似乎对改善视敏度（VA）和最大的治疗益处具有最佳效果。继续寻找递送玻璃体内药物的最佳方式。目前的方法包括缓释植入物和用于药物释放的水凝胶平台，而治疗干性和nAMD最有希望的未来途径是干细胞和基因治疗。
