Age-related macular degeneration (AMD) is a multifaceted disease characterized by early subclinical changes at the choroidea-retinal pigment epithelium interface. Both the causal and formal pathogenesis of the disease is still puzzling. Similarly, the reason for progression into two distinct late forms which are "geographic atrophy" and "choroidal neovascularization" remains enigmatic. Late changes are usually responsible for the dramatic loss in central function that has a devastating effect on quality of life. In industrialized countries the disease is a major cause for visual disability among persons over 60 years of age. Due to demographic right-shift and increased life expectancy, AMD is not only a medical problem but will have a pronounced socio-economic effect. Neovascular AMD with the development of choroidal neovascularization in the macular area accounts for 80% of the severe loss of visual acuity due to AMD. In the last decades, treatment modes were merely based on the destruction or surgical removal of the neovascular complex. In the present, however, the philosophical approach to treat the disease is changing to a pathology modifying manner. Intelligent targeting of the involved relevant factors and pathways should stop disease progression, reduce complications and improve vision. The first step into this new era has been accomplished with the introduction of antiangiogenic agents. The new agents act either directly on vascular endothelial growth factor (VEGF) or indirectly on its functional cascade. VEGF makes a fundamental contribution to neovascular processes but it also acts in physiological pathways. The main purpose of this review is to summarize its physiological role especially within the eye, the role in the development of AMD and to understand and foresee both the benefits and potential side-effects of the anti-VEGF-based therapy.

中文翻译：

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血管内皮生长因子和其他内源性参与者在年龄相关性黄斑变性中的作用。

年龄相关性黄斑变性（AMD）是一种多方面的疾病，其特征在于脉络膜-视网膜色素上皮界面的早期亚临床变化。该病的致病和正式发病机制仍然令人困惑。类似地，发展为两种不同的晚期形式的原因仍然是谜，即“地理萎缩”和“脉络膜新血管形成”。迟发变化通常是导致中枢功能急剧丧失的原因，这会对生活质量造成毁灭性影响。在工业化国家，该病是60岁以上人群视力残疾的主要原因。由于人口的右移和预期寿命的增加，AMD不仅是医疗问题，还将产生明显的社会经济影响。黄斑区脉络膜新血管形成发展的新血管性AMD占AMD严重视力丧失的80％。在过去的几十年中，治疗模式仅基于新血管复合物的破坏或手术切除。然而，目前，治疗该疾病的哲学方法正在改变为病理改变方式。对涉及的相关因素和途径的智能靶向可阻止疾病进展，减少并发症并改善视力。引入抗血管生成剂已经完成了进入这个新时代的第一步。新药直接作用于血管内皮生长因子（VEGF）或间接作用于其功能级联。VEGF对新生血管过程做出了根本性贡献，但它也在生理途径中起作用。这篇综述的主要目的是总结其生理作用，尤其是在眼睛内的生理作用，在AMD发生中的作用，并了解和预见基于抗VEGF的疗法的益处和潜在的副作用。