干性老年性黄斑变性的研究及治疗进展

Progress in research and treatment of dry age-related macular degeneration

老年性黄斑变性(AMD)是发达国家中老年人的主要致盲原因,在我国的发病率也呈逐渐上升的趋势。AMD在临床上常分为干性型和湿性型两种,本文主要探讨干性型AMD。作为环境因素和遗传因素共同作用的复杂眼底病变,干性型AMD的确切病因尚不清楚,近年来的研究表明年龄、吸烟、遗传、慢性光损伤等与其发病密切相关,氧化应激、炎症反应、脉络膜血流动力学改变在其病变过程中均起到了重要作用。干性型AMD根据病情进展可分为早期和晚期,晚期以地图状萎缩(GA)为特征,严重损害中心视力,然而,对于已造成严重视力损害的GA,并没有行之有效的治疗方法。近年来研究表明口服补剂(抗氧化剂、黄斑色素、矿物质)有助于减缓干性型AMD的进展和视力的丧失,其他如睫状神经营养因子、前列腺素E1等新型治疗方式也有报道证实其有效性。而对于胚胎干细胞移植、造血干细胞移植等有望逆转已受损中心视力的研究也在持续进行中,并取得了一定的进展。

Age-related macular degeneration(AMD) is the leading cause of blindness for the elderly in the developed countries. Meanwhile, the incidence increases over the past years in China. AMD is divided into two types as dry-AMD and wet-AMD clinically. Dry-AMD is mainly discussed in our article. As a complicated degenerative dysfunction caused by environmental and genetic factors, the pathogenesis of dry-AMD remains unclear. Many factors such as age, smoking, gene, and chronic light-induced injuries could possibly related to the incidence of dry-AMD, and many possible factors have been implicated to contributing in the pathogenesis including oxidative stress, inflammation and dysfunctional choroidal microcirculation. According to the progression of dry-AMD, it can be divided into early-AMD and late-AMD, and late-AMD is characterized by geographic atrophy(GA), which severely impairs central vision. However, there is no effective treatment for GA that has caused severe visual impairment. In recent years, studies have shown that oral supplements(antioxidants, macular pigments, minerals) can help to slow down the progress of dry AMD and the loss of vision. Other therapeutic approaches including ciliary neurotrophic factor, prostaglandin E1 have also been testified effective in saving the decreasing vision. Moreover, the studies of embryonic stem cells and hematopoietic stem cells transplantation are still under researching and with some success already, which are probably reverse the damaged central vision.