Intravitreal antivascular endothelial growth factor therapy during pregnancy: an update and current perspective

Many ocular neovascular diseases, including diabetic retinopathy (DR) and diabetic macular edema (DME), are significant complications that can worsen during pregnancy, posing risks to vision. Antivascular endothelial growth factor (anti-VEGF) agents represent the mainstay of DR and DME treatment in nonpregnant populations. However, their use in pregnant populations remain controversial due to concerns over fetal safety. This review explores the available literature on anti-VEGF use during pregnancy, evaluating maternal and fetal outcomes, and incorporating lessons learned from their recent use in treating retinopathy of prematurity (ROP).

Although human data on the safety of anti-VEGF agents during pregnancy remain limited, available studies suggest that systemic absorption is minimal, and concerns regarding potential effects on fetal angiogenesis largely theoretical. Case reports and retrospective studies have not consistently demonstrated harm. Furthermore, several studies examining long-term systemic effects of anti-VEGF use in treating premature infants with ROP reveal no association with adverse neurodevelopmental outcomes when compared to untreated ROP or ROP treated with laser photocoagulation alone.

While the use of anti-VEGF agents in pregnancy remains controversial, recent evidence suggests they should not be categorically excluded as a treatment option. Until more causal studies emerge, treatment decisions should be individualized, balancing disease severity, maternal visual function, and fetal safety.