Abstract
We review articles describing intravitreal injection of anti-VEGF drug trials, while discussing the mechanisms of the action of anti-VEGF antibodies, and also evaluating their outcomes. Intraocular injections of anti-VEGF drug are considered to be an effective treatment for macular edema after retinal vein occlusion, however, recurrent/persistent edema is common. The recent reports may lead to a shift in treatment paradigm for DME, from laser photocoagulation, to newer approaches using anti-VEGF drugs. There have been several well-publicized prospective, randomized studies that demonstrated the efficacy of intravitreal injection of anti-VEGF drugs for patients with AMD. Adjuvant bevacizumab for neovascular glaucoma may prevent further PAS formation, and it is likely to open up a therapeutic window for a panretinal photocoagulation and trabeculectomy. Intravitreal injection of bevacizumab (IVB) results in a substantial decrease in bleeding from the retinal vessels or new vessels during a standard vitrectomy. IVB has also been reported to be effective for inducing the regression of new vessels in proliferative diabetic retinopathy. The use of bevacizumab in stage 4 or 5 retinopahty of permaturity (ROP) is to reduce the plus sign to help reduce hemorrhage during the subsequent vitrectomy. Some authors reported cases of resolution of stage 4 A ROP after bevacizumab injection.
Highlights
Intravitreal injection of anti-VEGF agents has been reported to be effective for inducing the regression of new vessels in proliferative diabetic retinopathy (PDR) [19, 20, 33, 34] and neovascular glaucoma (NVG) [24,25,26,27,28,29,30,31,32, 35] and for improving the vascular permeability in macular edema [11,12,13,14,15,16,17,18]
Bleeding from the retinal vessels or new vessels during a standard vitrectomy after injection of bevacizumab (IVB) has been reported to occur significantly less frequently than that observed during a Journal of Ophthalmology standard vitrectomy without bevacizumab therapy [19, 33, 39,40,41]
Intraocular injections of 0.3 mg or 0.5 mg of ranibizumab provided a rapid improvement in the 6-month visual acuity and macular edema following branch retinal vein occlusion (BRVO), and treatments with ranibizumab as needed during months 6 through 11 maintained the visual and anatomic benefits achieved by 6 monthly injections, with low rates of ocular and nonocular safety events
Summary
Recent clinical trials regarding the intravitreal injection of anti-VEGF agents (ranibizumab, bevacizumab, pegaptanib, and aflibercept) have shown excellent results in the treatment of angiogenic pathologies including choroidal neovascularization [1,2,3,4,5,6,7,8,9,10], macular edema [11,12,13,14,15,16,17,18], proliferative diabetic retinopathy [19,20,21,22,23], and neovascular glaucoma (NVG) [24,25,26,27,28,29,30,31,32]. In the RanibizumaB for the Treatment of Macular Edema after BRAnch Retinal Vein Occlusion: Evaluation of Efficacy and Safety (BRAVO) study, 397 eligible patients were randomized 1 : 1 : 1 to receive 6 monthly intraocular injections of 0.3 mg or 0.5 mg of ranibizumab or sham injections during the 6-month treatment period. Intraocular injections of 0.3 mg or 0.5 mg of ranibizumab provided a rapid improvement in the 6-month visual acuity and macular edema following BRVO, and treatments with ranibizumab as needed during months 6 through 11 maintained the visual and anatomic benefits achieved by 6 monthly injections, with low rates of ocular and nonocular safety events. The mainstay of treatment for macular edema following BRVO is likely to involve frequent intraocular anti-VEGF injections with or without grid laser photocoagulation
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