J Korean Med Assoc.  2016 Jan;59(1):52-57. 10.5124/jkma.2016.59.1.52.

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

• Kang S

• KMID: 2195168
• DOI: http://doi.org/10.5124/jkma.2016.59.1.52

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 anti-VEGF 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.

Keyword

Intravitreal injections; Vascular endothelial growth factor; Ranibizumab; Bevacizumab; Aflibercept

MeSH Terms

Bevacizumab
Capillary Permeability
Endophthalmitis
Endothelial Growth Factors*
Humans
Immunoglobulin G
Intravitreal Injections*
Macular Degeneration
Macular Edema
Ranibizumab
Receptors, Vascular Endothelial Growth Factor
Retinal Diseases*
Retinaldehyde*
Vascular Endothelial Growth Factor A
Endothelial Growth Factors
Immunoglobulin G
Receptors, Vascular Endothelial Growth Factor
Retinaldehyde
Vascular Endothelial Growth Factor A

Reference

1. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY. MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1419–1431.

2. CATT Research Group. Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011; 364:1897–1908.

3. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U. VIEW 1 and VIEW 2 Study Groups. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmolog. 2012; 119:2537–2548.

4. Diabetic Retinopathy Clinical Research Network. Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, Ferris FL 3rd, Friedman SM, Glassman AR, Miller KM, Scott IU, Stockdale CR, Sun JK. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010; 117:1064–1077.

5. Diabetic Retinopathy Clinical Research Network. Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, Arnold-Bush B, Baker CW, Bressler NM, Browning DJ, Elman MJ, Ferris FL, Friedman SM, Melia M, Pieramici DJ, Sun JK, Beck RW. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015; 372:1193–1203.

6. IVAN Study Investigators. Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Wordsworth S, Reeves BC. Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology. 2012; 119:1399–1411.