Update on Combination Therapy in Wet Age-related Macular Degeneration

Daniele Veritti; Valentina Sarao; Paolo Lanzetta


Expert Rev Ophthalmol. 2010;5(5):681-688. 

In This Article

Abstract and Introduction


Age-related macular degeneration is the most common cause of choroidal neovascularization (CNV) and it is an important cause of vision loss in the ageing population. CNV is a multifactorial condition whose pathogenesis involves inflammation, angiogenesis and fibrosis. All available monotherapies are directed specifically to only one part of the CNV process. Combination therapy may act simultaneously on different pathways in the pathogenesis of CNV, resulting in additive or synergistic effects that may help to achieve good treatment outcome with few treatments needed. Large controlled studies are needed to achieve the best combination therapy for CNV.


Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. It can be classified into non-neovascular (dry) and neovascular (wet) forms. Dry AMD is the more prevalent type, accounting for approximately 90% of AMD cases.[1] However, wet AMD is responsible for 90% of the severe vision loss associated with AMD.[2,3] The neovascular form of AMD is characterized by the development of choroidal neovascularization (CNV). Pathological choroidal neovascularization is the result of a concatenation of subretinal changes in which hypoxia, inflammation and neoangiogenesis play a crucial role.[4] Thus, an ideal therapeutic goal should achieve not only CNV eradication, but also inflammation reduction and VEGF downregulation in order to produce a sustainable effect.[5]


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