《中国年龄相关性黄斑变性临床诊疗指南(2023年)》更新点  

Update points in the Evidence-based guidelines for diagnosis and treatment of age-related macular degeneration in China(2023)

作　　者：许迅[1] 刘堃[1] 苏莉 Xu Xun;Liu Kun;Su Li(Department of Ophthalmology,Shanghai General Hospital,School of Medicine,Shanghai Jiaotong University,National Clinical Research Center for Eye Disease,Shanghai 200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院眼科、国家眼部疾病临床医学研究中心,上海200080

出　　处：《中华眼底病杂志》2023年第11期879-882,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：《中国年龄相关性黄斑变性临床诊疗指南(2023年)》是我国第1部严格遵循世界卫生组织指南制订规范和国际指南标准制订的基于循证医学证据的年龄相关性黄斑变性(AMD)诊断和治疗临床实践指南。其主要的更新点:基于最新的循证医学证据和飞速发展的眼底影像学检查技术和设备,在AMD的诊断、治疗和随访方面进行了更新:基于新生血管在视网膜组织中的起源和存在部位不同,将黄斑区新生血管(MNV)分为了1型、2型和3型;对于新生血管性AMD,建议以光相干断层扫描(OCT)联合OCT血管成像作为检查和诊断方法;对于早至中期AMD,建议补充抗氧化维生素、锌、叶黄素、玉米黄质,或者混合型抗氧化维生素和矿物质;玻璃体腔注射抗血管内皮生长因子(VEGF)药物是累及中心凹或中心凹旁MNV的一线治疗方法,初始3个月每月注射1次+治疗并延长给药方案具有一定程度获益;对于抗VEGF药物3次负载治疗后无应答的新生血管性AMD,由临床医师综合考虑决定下一步治疗方案;对于非渗出性MNV,建议密切观察,一旦发现新生血管具有活动性,出现积液、渗出或出血等,应及时采用抗VEGF药物治疗。希望该指南能够帮助眼科医生提高AMD的诊疗、预防和随访水平。The Evidence-based guidelines for diagnosis and treatment of age-related macular degeneration in China(2023)is the first evidence-based clinical practice guidelines for the diagnosis and treatment of age-related macular degeneration(AMD)in China that strictly follows the WHO guideline formulation and international guideline standards.Based on the latest evidence-based medical evidence and the rapid development of ocular fundus imaging technology,the new version of the guidelines has been updated in the diagnosis,treatment and follow-up of AMD.Based on the origin and presence of neovascularization in retinal tissue,the macular neovascularizations are divided into type 1,type 2 and type 3 macular neovascularization(MNV).Optical coherence tomography(OCT)plus OCT angiography is recommended as the useful diagnostic method in neovascular AMD patients.Antioxidant vitamins,zinc,lutein,zeaxanthin,or a mix of antioxidant vitamins and minerals are recommended to prevent the progression of early to intermediate AMD.Intravitreal administration of anti-vascular endothelial growth factor(VEGF)agents is the first-line treatment for neovascular AMD,and once a month for the first 3 months plus treatment and prolonged administration regimen shows benefit to a certain extent.For poor response and non-response neovascular AMD patients,the clinician should decide the next treatment plan based on comprehensive consideration.Close observation is recommended for non-exudative MNV,and anti-VEGF therapy should be used promptly once non-exudative MNV transfer to exudative MNV.It is hoped that this guideline will improve the diagnosis,treatment,prevention and follow-up of AMDin China.

关 键 词：黄斑变性 诊疗准则 循证医学 述评 

分 类 号：R774.5[医药卫生—眼科]