视网膜血管瘤样增生治疗进展

Advances in the treatment of retinal angiomatous proliferation

视网膜血管瘤样增生(retinal angiomatous proliferation,RAP)是新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,n ARMD)的一种特殊病变类型,又称"3型新生血管"。其基本病变为新生血管形成,目前认为其新生血管起源于视网膜深层毛细血管。主要临床特征包括视网膜色素上皮层脱离(PED)和网状假性玻璃膜疣,分别与视网膜色素上皮层撕裂和地图样萎缩相关,最终可致严重的不可逆性视力损伤。其病程进展迅猛,多数早期患者可在6mo内发展至视力丧失。而传统治疗措施如激光疗法,疗效有限,预后较差。近年来,OCT血管造影(OCTA)等新技术从新的角度对RAP展开了探索,尤其在RAP的分期、基于分期的疗效观察等方面有了一定进展。大量有关玻璃体腔注射抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物治疗RAP的研究也证实了这种新兴疗法的安全性、有效性和优越性。这些均为临床选择治疗方案提供了依据。

Retinal angiomatous proliferation（RAP）, also known as ＂type 3 neovascularization＂, is a well-recognized variation of neovascular age-related macular degeneration（nARMD）. Neovascularization is the basic pathological characteristic. Current view on the origin of the neovascularization is the deep retinal capillaries. The main clinical features include retinal pigment epithelium detachment（PED）and reticular pseudodrusen. These two features have close relation to the retinal pigment epithelium（RPE）tear and geographic atrophy（GA）, respectively, which may ultimately result in severe irreversible visual impairment. The disease has a rapid natural course and the majority of patients in early stage can develop into vision loss within 6mo. However, classical therapeutic managements, such as laser therapy, have limited efficacy and poor prognosis. Recently, RAP has been further understood with the application of OCT angiography and other new technologies in diagnosing, staging and monitoring RAP. Varieties of research on intravitreal injection of anti-vascular endothelial growth factor（VEGF）treatment to RAP have also revealed its promising results and proved its safety as well as effectiveness. All these have provided new knowledge on choosing the optimal treatment regimen in clinical.