Intravitreal injection of anti-vascular endothelial growth factor for patients with various retinal diseases

Abstract

Vascular endothelial growth factor (VEGF-A) is a major regulator of angiogenesis and vascular permeability. VEGF-A plays an important role in a wide variety of retinal diseases. Therefore, intravitreal injection of anti-VEGF agents is increasingly used for the treatment of various vasoproliferative or exudative retinal diseases. There are several antiVEGF drugs available that are currently used, but three are most commonly used in practice. They are ranibizumab, bevacizumab, and aflibercept. Ranibizumab is a humanized monoclonal antibody fragment targeting VEGF-A, but bevacizumab, commonly used off-label, is a humanized full-length anti-VEGF antibody. Aflibercept is a recombinant fusion protein consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to the Fc portion of human IgG1. These anti-VEGF therapies have resulted in unprecedented visual and anatomic outcomes, especially in patients with neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME). Visual stabilization or clinically significant visual improvement can be expected if intravitreal injections of anti-VEGF agents are properly provided for patients with neovascular AMD or DME in the course of the disease. Treating retinal diseases with intravitreal injection of anti-VEGF agents may have potential side effects. Systemic adverse effects attributable to VEGF inhibition may cause thromboembolic events. Acute endophthalmitis is the most feared injection-related ocular side effect. The development of anti-VEGF agents for various retinal diseases provides a safe and effective treatment. There is no doubt that further advances in anti-VEGF therapy can be expected soon.