新生血管性年龄相关性黄斑变性治疗面临的挑战与对策

Challenges and strategies in the treatment of neovascular age-related macular degeneration

新生血管性年龄相关性黄斑变性(nAMD)是导致老年人致盲的主要原因之一,而抗血管内皮生长因子(VEGF)目前是主要的治疗方法。然而,在现实世界中,nAMD的治疗效果并不如人意,面临着多方面的挑战。频繁的药物给予和随访负担可能导致患者长期治疗中的依从性下降,进而导致治疗效果不足。部分病灶对抗VEGF治疗反应不佳,甚至无反应,视力获益难以维持甚至下降,而病灶的纤维化和组织萎缩等因素也会导致视力下降。因此,规范化和个体化的治疗方案,以及加强整个病程的监测管理,是目前可以采取的主要改进措施。中国年龄相关性黄斑变性临床诊疗指南发布于2023年,为临床提供规范的诊疗指导。同时,新药物和给药方法的研究开发是未来治疗的期望方向。

Neovascular age-related macular degeneration(nAMD)is a leading cause of blindness in the elderly,and anti-vascular endothelial growth factor(VEGF)therapy is currently the primary treatment approach.However,the real-world effectiveness of nAMD treatment is not always satisfactory and faces various challenges.Frequent administration and follow-up burdens can lead to decreased patient compliance during long-term treatment,resulting in suboptimal outcomes.Some lesions exhibit poor or no response to anti-VEGF treatment,leading to difficulties in maintaining or even declining visual acuity.Factors such as lesion fibrosis and tissue atrophy can contribute to visual deterioration.Therefore,standardizing and individualizing treatment plans,along with enhancing comprehensive monitoring and management throughout the disease course,are crucial improvement measures.The evidence-based guidelines for diagnosis and treatment of age-related macular degeneration in China,released in 2023,provide guidance for standardized clinical diagnosis and treatment.Meanwhile,research and development of new drugs and administration methods are anticipated for the future.