title: [Review and expert opinion in age related macular degeneration. Focus on the pathophysiology, angiogenesis and pharmacological and clinical data].
abstract: Age related macular degeneration (AMD) is a pathological aging of the macula, brought about by the interaction of genetic and environmental factors. It induces geographic atrophy of the retina and/or choroidal neovascularization. In the latter, abnormal vessels develop from the choriocapillaris, with the involvement of VEGF (vascular endothelial growth factor). The VEGF family includes several factors, including VEGF-A, B, C, D, F and PlGF (placental growth factor). Their biological properties and their affinities to the VEGFR1, VEGFR2 and VEGFR3 receptors found on endothelial cells differ. Exudative AMD involves mainly VEGF-A and VEGF-R2. Anti-VEGF agents used in ophthalmology (ranibizumab, bevacizumab and aflibercept) are designed to primarily target this pathway. In vitro, all have sufficient affinity to their ligands. Their therapeutic efficacy must therefore be judged based on clinical criteria. In clinical practice, the minimum number of injections required for a satisfactory result appears to be comparable with all the three. The few available studies on therapeutic substitutions of anti-VEGF compounds suggest that some patients may benefit from substituting the anti-VEGF in cases of an unsatisfactory response to an initial molecule. Although local side effects, including increased risk of geographic atrophy, and systemic effects, including vascular accidents, have been suggested, these risks remain low, specially compared to the benefits of the treatment. Differences in safety between anti-VEGF are theoretically possible but unproven.
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.affiliation: Inserm, institut de la vision, 17, rue Moreau, 75012 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Sennlaub
authors.affiliation: Centre hospitalier intercommunal de Créteil (CHIC), 40, avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Souied
authors.affiliation: Centre ophtalmologique d'imagerie et de laser (CIL), 11, rue Antoine-Bourdelle, 75015 Paris, France.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Cohen
authors.affiliation: Centre de recherche des cordeliers (CRC), hôpital Hôtel-Dieu, 15, rue de l'École-de-Médecine, 75006 Paris, France; Centre de recherche des cordeliers (CRC), hôpital Hôtel-Dieu, 15, rue de l'École-de-Médecine, 75006 Lausanne, Suisse.
authors.forename: F
authors.initials: F
authors.lastname: Béhar-Cohen
authors.affiliation: EA 3836, unité d'oncopharmacologie, centre André-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 02, France.
authors.forename: G
authors.initials: G
authors.lastname: Milano
authors.affiliation: Service d'ophtalmologie, hôpital Lariboisière, AP-HP, université Paris 7, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: ramin.tadayoni@lrb.aphp.fr.
authors.forename: R
authors.initials: R
authors.lastname: Tadayoni
mesh_terms: D000375:Aging / Q000502:physiology; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy; D004361:Drug Tolerance; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012160:Retina / Q000502:physiology; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Age related macular degeneration (AMD); Anti-VEGF; Dégénérescence maculaire liée à l’âge (DMLA); Macula; Retina; Rétine; Vascular endothelial growth factor (VEGF)