渗出型老年性黄斑变性治疗中抗血管内皮生长因子药物治疗中更换应用的研究进展

Progresses in the treatment of exudative age-related macular degeneration with anti-vascular endothelial growth factor drugs

玻璃体腔注射抗血管内皮生长因子（VEGF）药物治疗渗出型老年性黄斑变性（wAMD）的有效性已被证实，其药物包括贝伐单抗、雷珠单抗等单克隆抗体类药物和阿柏西普、康柏西普等融合蛋白类药物。但仍有部分患者经抗VEGF药物治疗后疗效不佳，包括初治无应答或应答不佳，甚至治疗过程中病情反复。由于抗VEGF药物的作用靶点及分子特点不同，抗VEGF药物的更换应用以及给药模式、给药剂量、给药间歇期的调整等，成为疗效欠佳的应对策略。但现存的众多研究所得结果不尽相同，视网膜解剖结构的恢复获益更多，视力改善相对困难。何种治疗方案获益最大，仍有待大样本临床随机对照研究和长期随访进一步探索。

Intravitreal injections of anti-vascular endothelial growth factor （anti-VEGF） drugs, including monoclonal antibodies （such as bevacizumab and ranibizumab） and fusion protein agents （such as aflibercept and conbercept） have been proven to be effective in the treatment of wet age-related macular degeneration （wAMD）. However, there are still some patients with poor efficacy, such as no response to initial treatment or poor response, and even relapse during the course of treatment. In view of the different targets and molecular characteristics of anti-VEGF drugs, the switch of anti-VEGF drugs and the adjustment of delivery pattern, dosages and intervals have been the strategies to cope with the poor efficacy in clinic. However, there are some differences in the results of current studies. Overall, the recovery of retinal anatomical outcome achieves more benefits, and it is relatively difficult to improve visual acuity. To determine which regimen would get the biggest benefits, a large number of randomized controlled clinical trials and long study period will be needed.