7其他药物
低分子量肝素(LMWH)是一种广泛用于临床的抗血栓形成药物,近年动物研究发现其还具有抑制VEGF诱发的新生血管形成的作用[29]。干扰素(IFN)是第1个进入临床的新生血管抑制剂。在对体外培养的血管内皮细胞抑制作用的实验中[30],证实IFNγ有较强的抑制作用,而且是生物制剂,具有毒性低、容易取得、对正常成熟的血管影响小等优点。是很有临床应用前途的新生血管抑制药物。奥曲肽是一种生长抑素的长效类似物,对IGF1有显著的抑制作用,可通过这一作用影响VEGF的表达,从而减少内皮细胞的成活[31]。有实验[32]证实尼莫地平在某种程度上能抑制VEGF的表达,其机制为VEGF能够通过激活细胞膜钙通道增加细胞外钙离子内流促进细胞增殖,钙通道拮抗剂尼莫地平则通过抑制钙离子内流抑制增殖性病变的发生。
随着分子生物学的不断发展,人们对新生血管病理机制的认识不断深入,视网膜新生血管的药物治疗无疑成为一种颇具潜力治疗的方法。但在选择抗新生血管药物时,我们尚需注意最佳的给药方法。首先,重复玻璃体腔注射存在感染、出血及视网膜脱离的危险,因此,近黄斑部后巩膜旁注射或玻璃体腔植入药物缓释系统应该是个不错的选择。其次,目前研究的大多数抗新生血管药物能阻止新生血管的发展,而不能使已生长的新生血管消退,如果能在临床上使已经发生的新生血管消退,将会大大减少新生血管对眼部的危害。
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