2.3.2 Pegaptanib对早期湿性AMD的治疗  早期湿性AMD的眼底病变相对较轻，推测在此时进行治疗将有可能通过抑制新生血管的渗漏来减轻其对光感受器细胞和视网膜色素上皮的损害，从而可能较好的改善视功能。为此，针对VISION试验进行了一项回顾性研究，分析了0.3mg Pegaptanib组治疗早期湿性AMD 54wk后的视力改变情况。依据以下两种方法界定早期湿性AMD。第1种方法为：病灶范围<2个视盘区；基础视力≥54个字母；未接受过PDT或激光光凝术治疗；病灶无瘢痕或萎缩；第2种方法为：隐匿性且无典型性CNV；无渗漏；对侧眼比治疗眼的基础视力好。将Pegaptanib 0.3mg组的患者分别按以上两种判定方法分为两个亚组（n 1=34，n 2 =30），另外还为2个治疗亚组分别选取了对照组（n 1=28，n 2=35）。

    通过分析发现，两个亚组视力下降小于15个字母的比例分别为76%（26/34）和80%（24/30），而对照组分别为50%（14/28，P =0.03）和57%（20/35，P =0.05）。对照组平均视力比治疗组多下降了11.1个和12.7个字母读数（P <0.01、P <0.006）。视力提高3行以上的患者比例，在第1组为12%（4/34），其对照组为4%（1/28）；第2组为20%（6/30），对照组则无1例（P =0.006）。

    以上结果已显示出Pegaptanib对早期湿性AMD患者的视功能改善具有积极的意义。但由于对疾病早期的定义尚无统一标准，且此项回顾性研究的样本量较小，因此仍需进行更加科学、全面和系统性的研究，以验证此结论[25]。

    4小结

    尽管目前临床上治疗以AMD为代表的CNV相关性疾病的疗法有许多，但由于VEGF在新生血管形成中具有的关键作用，针对VEGF的抑制疗法将可能会成为一种更加科学有效的治疗途径[26-28]。作为第一种应用于眼科临床的VEGF抑制剂，临床试验的结果已初步显示出Pegaptanib治疗眼底新生血管性疾病的优越性。随着对CNV发生机制的深入研究，针对CNV病因进行的治疗将有助于保持和改善患者的视力，提高生活质量，为预防和治愈AMD及其他CNV相关疾病带来新的希望。

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