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Review
. 2019 Apr 4;20(7):1693.
doi: 10.3390/ijms20071693.

Therapeutic Approaches with Intravitreal Injections in Geographic Atrophy Secondary to Age-Related Macular Degeneration: Current Drugs and Potential Molecules

Marcella Nebbioso  1 , Alessandro Lambiase  2 , Alberto Cerini  3 , Paolo Giuseppe Limoli  4 , Maurizio La Cava  5 , Antonio Greco  6
Affiliations
Review

Therapeutic Approaches with Intravitreal Injections in Geographic Atrophy Secondary to Age-Related Macular Degeneration: Current Drugs and Potential Molecules

Marcella Nebbioso et al. Int J Mol Sci. .

Abstract

The present review focuses on recent clinical trials that analyze the efficacy of intravitreal therapeutic agents for the treatment of dry age-related macular degeneration (AMD), such as neuroprotective drugs, and complement inhibitors, also called immunomodulatory or anti-inflammatory agents. A systematic literature search was performed to identify randomized controlled trials published prior to January 2019. Patients affected by dry AMD treated with intravitreal therapeutic agents were included. Changes in the correct visual acuity and reduction in geographic atrophy progression were evaluated. Several new drugs have shown promising results, including those targeting the complement cascade and neuroprotective agents. The potential action of the two groups of drugs is to block complement cascade upregulation of immunomodulating agents, and to prevent the degeneration and apoptosis of ganglion cells for the neuroprotectors, respectively. Our analysis indicates that finding treatments for dry AMD will require continued collaboration among researchers to identify additional molecular targets and to fully interrogate the utility of pluripotent stem cells for personalized therapy.

Keywords: age-related macular degeneration; anti-inflammatory agents; complement inhibitors; dry AMD; geographic atrophy; intravitreal injection; neuroprotective agents; non-exudative AMD.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Imaging of geographic atrophy (GA). En-face and B-scan spectral-domain optical coherence tomography (SD-OCT). Decreased macular thickness (center marker 89/78 µm), retinal pigment epithelial (RPE) irregularities, and of the underlying choriocapillaris. The atrophic area shows hyperreflective clumps at different levels, segmented plaques of the outer band and elevations with variable reflectivity. GA is a form of advanced dry age macular degeneration (AMD). An eye may have uni- or multi-focal atrophic lesions, which, when summed, determine the central total lesion area. Scale bars = 200 μm.
Scheme 1
Scheme 1
Diagram outlining the complement pathways. Three pathways of complement activation: classical, lectin, and alternative. MBL: mannose-binding lectin; MASP: MBL-associated serine proteases, MASP-1, and MASP-2.
Figure 2
Figure 2
The intravitreal injection (IVI) is a procedure to place a medication directly into the vitreous cavity. IVIs are used to administer medications in various retinal conditions. Representation of molecules, neuroprotective, immunomodulatory or anti-inflammatory agents, which have been used for IVIs in patients with geographic atrophy (GA). MBL: mannose-binding lectin; MASP: MBL-associated serine proteases, MASP-1, and MASP-2; sTCC: soluble terminal complement complex; MAC: membrane attack complex.
See this image and copyright information in PMC

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