抗血管内皮生长因子药物治疗无应答的原因与应对措施

The causes and countermeasures of non-response to anti-vascular endothelial growth factor therapy

抗血管内皮生长因子（VEGF）药物治疗反应存在个体差异。根据治疗前后视网膜中央厚度、视网膜内积液、视网膜下积液等形态和最佳矫正视力等功能变化，患眼的应答表现可分为理想应答、弱应答和无应答三种情况。导致抗VEGF药物治疗无应答的原因主要与基因多态性及特定基因型风险、病灶特点、合并玻璃体黄斑结构异常、抗VEGF药物抵抗以及周细胞的作用等因素有关。其应对措施包括增加治疗剂量、缩短注射间期、更换药物；靶向抑制周细胞；解除玻璃体黄斑解剖异常。但如何个体化评估无应答原因，针对性地给予正确处理，减少抗VEGF药物的过度使用，完善眼部新生血管疾病的临床管理仍值得进一步探索。

The therapeutic response of anti-vascular endothelial growth factor （VEGF） differs among individuals. According to the changes of central retinal thickness, intraretinal fluid, subretinal fluid, best corrected visual acuity and other morphological or functional manifestations after treatment, the performance of the treated eyes can be classified as optimal response, poor response and non-response. A variety of factors could account for poor or non-response to anti-VEGF, such as genomic polymorphism and specific genomic risk alleles, lesion characteristics, vitreous and macular structural abnormalities, resistance to anti-VEGF drug, and the role of pericytes and others. The common counter measures include increasing the dosage, shortening the injection interval and replacing with another alternative drug, inhibition of pericytes, relieving vitreomacular anatomical abnormalities. It is still worthy of further exploration that how to assess individual reasons for non-response, so that we can give proper treatment to reduce the excessive use of ant[- VEGF drugs and improve the clinical management of ocular neovascularization diseases.