Anti-vascular endothelial growth factor in ophthalmology

Abdul Mahir, Fathima Sakeena
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Vascular endothelial growth factor, secreted by the neurovascular retina, acts as an essential regulator in vasculogenesis, angiogenesis, and increased vascular permeability, which plays a critical role in the pathophysiology of ischemia-related retinal illnesses, inducing aberrant neovascularization, edema, and further complications, all of which contribute to a progressive diminution of visual acuity. Based on an intrinsic understanding of VEGF biology and its critical role in ocular pathogenesis, various anti-VEGF strategies tailored specifically to ophthalmologic illnesses were conceived. Pegaptanib, bevacizumab, ranibizumab, aflibercept, and the more recently authorized brolucizumab and faricimab, have all undergone rigorous trials and are now used to treat a vast array of conditions, both on-label and off-label, with more studies underway to further expand their indications. These drugs proved to be quite valuable, providing physicians with a treatment alternative that could lead to visual gains as well as offering new hope for patients suffering from retinal diseases where blindness was previously a sure outcome. Nonetheless, despite their impressive track record, intravitreal anti-VEGF inhibitors are not without their shortcomings, some of which include a high treatment burden, monetary implications, poor patient compliance, and limited visual gains. On the bright side, much research is ongoing to address these concerns to bring about agents with better durability and fewer adverse effects. Novel delivery approaches, dual agents acting on additional cytokine pathways, and gene therapy are just some of the few cutting-edge strategies that are being employed. And, almost two decades since the debut of anti-VEGF therapeutics, a new era of a more affordable ocular anti-VEGF therapy has dawned with the arrival of biosimilars and biobetters in the market.
Ophthalmology, Anti-VEGF, Bevacizumab