Anti-vascular endothelial growth factors in retinal and choroidal diseases - Present landscape

Anti-vascular endothelial growth factors (anti-VEGFs) are agents that block the activity of specific bio-active molecules responsible for the growth of abnormal blood vessels. The advent of anti-VEGF therapy has revolutionized the treatment of retinal diseases. They are commonly indicated for diabetic macular edema, choroidal neovascular membrane, cystoid macular edema due to retinal vein occlusion, neovascular glaucoma, and retinopathy of prematurity. The commonly available anti-VEGF agents are bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab. The currently practiced treatment regimens include fixed dosing, pro-re-nata, and treat-and-extend. Additionally, biosimilars represent a pivotal shift, offering cost-effective alternatives without compromising therapeutic value. Studies on sustained release anti-VEGF medications like port delivery systems and biodegradable depots are yielding promising outcomes. Ongoing studies analyze the long-term effects of anti-VEGF therapy, aiming to develop next-generation agents with greater durability, efficacy, and safety. This further reduces the treatment burden and offers an extra edge in optimizing long-term visual outcomes. This article provides a comprehensive overview of anti-VEGF therapies including their mechanism of action, efficacy and safety profiles, and landmark trials that have shaped their use in clinical practice. This was a narrative review of the literature that was conducted using PubMed, MEDLINE, Scopus Cochrane library databases, and Google Scholar databases.