白内障是全球第一大致盲眼病，表现为由多种原因导致的晶状体病变，进而出现视物模糊的现象，严重者会进一步丧失视力。白内障的类型较多，发病机制尚未完全阐释清楚，氧化应激是目前公认的主要影响因素。药物治疗一直是白内障患者临床治疗的一大难题，目前市面上还没有能够真正逆转白内障的药物，现有的药物仅能在一定程度上缓解白内障的进展。手术治疗仍是现阶段唯一有效的治疗方式，但经济因素和术后并发症的风险限制了部分患者通过手术恢复视力。白内障的治疗一直是眼科领域研究的重点，目前研究主要集中在两个战略方向上：优化手术技术并结合更优的围术期药物治疗方案以减少并发症，以及对疾病机制进行基础研究以促进新靶点药物的发现。有效的药物治疗一直是目前临床治疗的一大缺口，近年来研究者在白内障机制探索和新药研发上取得了显著进展，多个新的治疗靶点以及相关治疗药物不断被发现，但相关药物真正进入临床还面临着诸多挑战。文章主要从机制研究进展、药物治疗现状和前景较好的白内障药物临床研究进展等进行综述，旨在为新的白内障药物研发提供最新的参考。
Cataracts remain the leading cause of blindness globally. They manifest as lens opacification triggered by various factors, leading to blurred vision. In severe cases, patients may eventually lose their vision entirely. There are many types of cataracts, and their pathogenesis has not been fully clarified. Currently, oxidative stress is widely acknowledged as the primary influencing factor. Pharmacological intervention remains a significant clinical challenge in cataract management. At present, there are no drugs on the market capable of truly reversing cataracts; existing medications can only alleviate the progression of the condition to a certain extent. Surgical treatment remains the only effective approach at this stage. However, economic limitations and the risks of postoperative complications hinder its accessibility for certain patient groups. The treatment of cataracts has consistently been a research hotspot in the field of ophthalmology. Current research mainly centers on two strategic approaches: optimizing surgical techniques alongside improved perioperative pharmaceutical regimens to minimize complications, and conducting basic researches on disease mechanisms to facilitate drug discovery. Effective drug treatment has long been a major gap in current clinical treatment. In recent years, significant progress has been achieved in the exploration of cataract mechanisms and the development of new drugs. Despite the remarkable advancements in uncovering cataract pathogenesis and identifying novel therapeutic targets in recent years, substantial challenges remain in translating these discoveries into clinically applicable medications. This article reviews the progress in mechanism research, the current state of pharmacological interventions, and the clinical research developments of several promising cataract drugs, aiming to provide the latest reference for the research and development of new cataract drugs.
目的：调查抗VEGF药物治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration, wAMD)5年的疗效。方法：2011年至2021年于北京医院眼科诊断为wAMD的患者共84人103只眼进行回顾性分析。抗VEGF治疗采用3+PRN方案。观察5年来的最佳矫正视力(best-corrected visual acuity，BCVA)、玻璃体腔注射次数、随访次数和病灶的解剖学变化。结果：治疗5年后平均BCVA为38.1个字母，与基线相比下降9.4个字母，差异有统计学意义(P<0.001)。23.3%的患眼5年后可维持初始视力。5年内平均注射次数为13.8次，第1年注射次数最多，平均为4.3次。5年内平均随访次数为24.3次，仅有34.0%的患眼可遵循每次随访间隔≤3个月。5年后有68.0%的患眼出现纤维瘢痕，27.2%的患眼出现地图样萎缩，69.0%(71/103)的患眼存在持续的色素上皮脱离(pigment epithelial detachment，PED)。年龄、基线BCVA、是否初始治疗、随访年限、注射次数、中心视网膜厚度 (central retina thickness，CRT)、地图样萎缩等对BCVA有显著影响。结论：多数患者在抗VEGF治疗1年内可维持视力，但5年以上维持效果不佳。早期诊治、提高注射频率，可能是未来改善预后的研究方向。
Objective:To investigate the efficacy of anti-VEGF injection in the treatment of wet age-related macular degeneration (wAMD) for 5 years. Methods: A total of 84 patients (103 eyes) wAMD diagnosed in Department of Ophthalmology in Beijing Hospital from 2011 to 2021 were analyzed retrospectively. 3 + PRN regimen was applied for anti-VEGF treatment. The changes of best corrected visual acuity (BCVA), the number of intravitreal injections and the number of follow-up visits, and the anatomical changes of the lesions in the past 5 years were collected. Results: The average BCVA after 5 years was 38.1 letters, indicating a decrease of 9.4 letters comparing to baseline, which was statistically significant (P<0.001). 23.3% of the eyes could maintain the baseline BCVA after 5 years. The average injection times within 5 years was 13.8, and the injection was concentrated in the first year, with an average of 4.3. The average number of follow-up visits within 5 years was 24.3, and only 34.0% of the affected eyes could keep the follow-up interval ≤3 months. After 5 years, 68.0% of the eyes developed fibrous scar, 27.2% developed geographic atrophy, and 69.0% (71/103) had consistent pigment epithelial detachment. Factors significantly affect BCVA include: age, baseline BCVA, initial treatment, follow-up time, injection times, central retinal thickness, geographic atrophy and so on. Conclusion: Most patients can maintain vision within the first year after anti-VEGF treatment, but the efficacy is poor for more than 5 years. Early diagnosis and treatment, and increased injection frequency may be the research direction for improving prognosis in the future.
单纯疱疹病毒基质型角膜炎是引起角膜盲的主要原因之一，目前以局部使用糖皮质激素联合口服抗病毒药物治疗为主。传统治疗存在生物利用度低、药物不良反应等缺点，因此亟需寻找替代药物、开发新剂型。环孢素A和他克莫司等免疫抑制剂疗效明显、不良反应少，可能是糖皮质激素的潜在替代品。α干扰素联合阿昔洛韦可缩短病程，而单独使用效果有限。基质再生剂具有新的抗病毒机制，值得进一步研究。此外，纳米载体递送系统，如脂质体、纳米胶束、立方液晶纳米粒，由于能够增强药物角膜穿透性和延长药物释放，在治疗基质型单纯疱疹性角膜炎方面具有巨大潜力。
Herpes simplex virus stromal keratitis is one of the leading causes of corneal blindness. A topical corticosteroidagent in conjunction with an oral antiviral agent is the preferred treatment, which has the disadvantages of low bioavailability and drug side effects. Therefore, there is an urgent need to find alternative drugs and develop new dosage forms. Immunosuppressants such as cyclosporine A and tacrolimus have obvious curative effects and few side effects, and may be potential substitutes for glucocorticoids. Interferon-α combined with acyclovir can shorten the course of disease, but the effect is not obvious when used alone. Matrix regenerating agents have new antiviral mechanisms and deserve further study. In addition, nanocarriers delivery systems, such as liposomes, nanomicelles and cubosomes, have great potential in the treatment of herpes simplex virus stromal keratitis due to their ability to enhance drug corneal penetration and prolong drug release.
