Advances in the treatment of atrophic age-related macular degeneration_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Yang ^1,2 , Wang Junwen ² , Li Yin ² ,  Li Tuo ²

1. Hubei University of Medicine Graduate School, Shiyan 442000, China;
2. Department of Ophthalmonogy, Central Hospital of Enshi Autonomous Prefecture, Enshi 445000, China;

Corresponding author：

Li Tuo, Email: 13986840088@139.com

Keywords：

Age-related macular degeneration; Dry age-related macular degeneration; Drusen; Treatment; Review

DOI：

10.3760/cma.j.cn511434-20240717-00273

Video：

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Abstract Full text Figures/Tables Video References Cited by

Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss. There are two primary forms of AMD: wet age-related macular degeneration (WAMD) and dry age-related macular degeneration (DAMD). While numerous medications are currently available for the treatment of WAMD, yielding significant therapeutic outcomes, effective treatments for DAMD remain scarce. Various animal studies and clinical trials on DAMD treatment have been conducted, focusing primarily on antioxidants, complement pathway inhibitors, mitochondrial protectors, visual cycle inhibitors, neuroprotectants, amphiphilic polymer-based drug delivery systems, cell therapy, photobiomodulation therapy, gene therapy, surgical interventions, and traditional Chinese medicine. Among these, antioxidant supplementation with vitamins and complement pathway inhibitor APL-2 and ACP have received Food and Drug Administration approval for the treatment of DAMD. With the continuous development of the medical field, the future will explore the treatment methods with little trauma, good efficacy and good patient compliance, and successfully achieve clinical transformation.

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2. Guymer RH, Campbell TG. Age-related macular degeneration[J]. Lancet, 2023, 401(10386): 1459-1472. DOI: 10.1016/S0140-6736(22)02609-5.
3. Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis[J/OL]. Lancet Glob Health, 2014, 2(2): e106-e116[2014-01-03]. https://pubmed.ncbi.nlm.nih.gov/25104651/. DOI: 10.1016/S2214-109X(13)70145-1.
4. Ye H, Zhang Q, Liu X, et al. Prevalence of age-related macular degeneration in an elderly urban Chinese population in China: The Jiangning Eye Study[J]. Invest Ophthalmol Vis Sci, 2014, 55(10): 6374-6380. DOI: 10.1167/iovs.14-14899.
5. Girgis S, Lee LR. Treatment of dry age-related macular degeneration: a review[J]. Clin Exp Ophthalmol, 2023, 51(8): 835-852. DOI: 10.1111/ceo.14294.
6. Han S, Chen J, Hua J, et al. MITF protects against oxidative damage-induced retinal degeneration by regulating the NRF2 pathway in the retinal pigment epithelium[J/OL]. Redox Biol, 2020, 34: 101537[2020-04-16]. https://pubmed.ncbi.nlm.nih.gov/32361183/. DOI: 10.1016/j.redox.2020.101537.
7. Tang Y, Kang Y, Zhang X, et al. Mesenchymal stem cell exosomes as nanotherapeutics for dry age-related macular degeneration[J]. J Control Release, 2023, 357: 356-370. DOI: 10.1016/j.jconrel.2023.04.003.
8. Li F, Lang F, Zhang H, et al. Apigenin alleviates endotoxin-induced myocardial toxicity by modulating inflammation, oxidative stress, and autophagy[J/OL]. Oxid Med Cell Longev, 2017, 2017: 2302896[2017-07-30]. https://pubmed.ncbi.nlm.nih.gov/28828145/. DOI: 10.1155/2017/2302896.
9. Zhang Y, Yang Y, Yu H, et al. Apigenin protects mouse retina against oxidative damage by regulating the Nrf2 pathway and autophagy[J/OL]. Oxid Med Cell Longev, 2020, 2020: 9420704[2020-05-13]. https://pubmed.ncbi.nlm.nih.gov/32509154/. DOI: 10.1155/2020/9420704.
10. Wang B, Wang L, Gu S, et al. D609 protects retinal pigmented epithelium as a potential therapy for age-related macular degeneration[J]. Signal Transduct Target Ther, 2020, 5(1): 20. DOI: 10.1038/s41392-020-0122-1.
11. Pardue MT, Allen RS. Neuroprotective strategies for retinal disease[J]. Prog Retin Eye Res, 2018, 65: 50-76. DOI: 10.1016/j.preteyeres.2018.02.002.
12. Rhoades W, Dickson D, Do DV. Potential role of lampalizumab for treatment of geographic atrophy[J]. Clin Ophthalmol, 2015, 9: 1049-1056. DOI: 10.2147/opth.S59725.
13. Anderson DH, Mullins RF, Hageman GS, et al. A role for local inflammation in the formation of drusen in the aging eye[J]. Am J Ophthalmol, 2002, 134(3): 411-431. DOI: 10.1016/s0002-9394(02)01624-0.
14. Garg A, Nanji K, Tai F, et al. The effect of complement C3 or C5 inhibition on geographic atrophy secondary to age-related macular degeneration: a living systematic review and meta-analysis[J]. Surv Ophthalmol, 2024, 69(3): 349-361. DOI: 10.1016/j.survophthal.2023.11.008.
15. Danzig CJ, Khanani AM, Loewenstein A. C5 inhibitor avacincaptad pegol treatment for geographic atrophy: a comprehensive review[J]. Immunotherapy, 2024, 29: 1-12. DOI: 10.1080/1750743x.2024.2368342.
16. Jaffe GJ, Westby K, Csaky KG, et al. C5 inhibitor avacincaptad pegol for geographic atrophy due to age-related macular degeneration[J]. Ophthalmology, 2021, 128(4): 576-586. DOI: 10.1016/j.ophtha.2020.08.027.
17. Khanani AM, Patel SS, Staurenghi G, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial[J]. Lancet, 2023, 402(10411): 1449-1458. DOI: 10.1016/s0140-6736(23)01583-0.
18. Yehoshua Z, de Amorim Garcia Filho CA, Nunes RP, et al. Systemic complement inhibition with eculizumab for geographic atrophy in age-related macular degeneration[J]. Ophthalmology, 2014, 121(3): 693-701. DOI: 10.1016/j.ophtha.2013.09.044.
19. Heier JS, Lad EM, Holz FG, et al. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials[J]. Lancet, 2023, 402(10411): 1434-1448. DOI: 10.1016/s0140-6736(23)01520-9.
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