AGE-RELATED MACULAR DEGENERATION CURRENT INVESTIGATIONS AND TREATMENTS

agerelatedmaculardeg774enerationkapak

COMBINATION THERAPIES FOR WET AGE-RELATED MACULAR DEGENERATION

Mahmut Asfuroğlu

Ankara Bilkent City Hospital, Department of Ophthalmology, Ankara, Türkiye

Asfuroğlu M. Combination Therapies for Wet Age-Related Macular Degeneration. In: Çıtırık M, Şekeryapan Gediz B, editors. Age-Related Macular Degeneration: Current Investigations and Treatments. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.209-217.

ABSTRACT

Age-related macular degeneration (AMD) is among the most widespread causes of irreversible blindness on a global scale. AMD is a chronic, degenerative disease of the retina, affecting the macula, which is characterised by its progressive nature. The infiltration of atypical blood vessels from the choroidal circulation is the underlying cause of retinal damage and severe visual impairment. The standard approach to first-line therapy is centered on the suppression of vascular endothelial growth factor (VEGF), a potent angiogenic factor that has been shown to induce vessel growth and augment vascular permeability. Despite the advances that have been made in the field, it is evident that up to 50% of patients demonstrate an incomplete response to the available anti-VEGF treatments, even among those patients who initially respond to treatment. The limitations of monotherapies in addressing the multifactorial pathogenesis of wet AMD have given rise to a surge of interest in combination therapies. The primary goal of combination therapy in wet AMD is to reduce inflammation, effectively address existing choroidal neovascularisation (CNV), and prevent subsequent CNV, while simultaneoulsy reducing VEGF expression. It has been hypothesised that the distinct mechanisms of action inherent in combination treatments possess the capacity to more effectively address the complex pathogenetic factors contributing to wet AMD than any individual monotherapy. Consequently, the hypothesis can be advanced that combination therapy may offer patients suffering from wet AMD benefits due to the utilisation of a range of different mechanisms which may even be complementary or synergistic in nature. The principal aim of current trials is to ascertain a treatment that will enhance vision with minimal administration, optimally within a single cycle, while ensuring both efficacy and tolerability are maintained.

Keywords: Macular degeneration, age related; Vascular endothelial growth factors; Dexamethasone; Platelet-derived growth factor; Intravitreal injections

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