Anti-Vascular Endothelial Growth Factor Agents for Ocular Angiogenesis and Vascular Permeability

Copyright © 2012 Toshiaki Kubota et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Recent clinical trials regarding the intravitreal injection of antivascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, pegaptanib, and aflibercept) have shown excellent results in the treatment of angiogenic pathologies including choroidal neovascularization, macular edema, proliferative diabetic retinopathy, and neovascular glaucoma. Ranibizumab (Lucentis, Genectech, San Fran-cisco), a fragment of a humanized monoclonal antibody against all VEGF isoforms, is beneficial in the treatment of choroidal neovascularization secondary to age-related macu-lar degeneration (AMD). Bevacizumab (Avastin, Genentech, San Francisco), a humanized, recombinant monoclonal IgG antibody that binds and inhibits all VEGF isoforms, has been approved as an adjuvant agent for the treatment of colorectal carcinoma and has also been increasingly used as an offlabel therapy in the field of ophthalmology. Pegaptanib (Mucugen, Pfizer, New York) is a 28-base ribonucleic acid aptamer, covalently linked to two branched 20-kD polyethylene glycol moieties, that was developed to bind and block the activity of extracellular VEGF, specifically the 165-aminoacid isoform (VEGF165). Aflibercept) is a 115-kDa recombinant fusion protein consisting of the VEGF-binding domains of human VEGF receptors 1 and 2 fused to the Fc domain of human immunoglobulin-G1. Intraocular injections of anti-VEGF drug are considered to be an effective treatment for macular edema after retinal vein occlusion. The recent reports may lead to a shift in treatment paradigm for diabetic macular edema, from laser photocoagulation to newer approaches using anti-VEGF drugs. There have been several well-publicized prospective , randomized studies that demonstrated the efficacy of intravitreal injection of anti-VEGF drugs for patients with AMD. Adjuvant bevacizumab for neovascular glaucoma may prevent further peripheral anterior synechiae formation, and it is likely to open up a therapeutic window for a panretinal photocoagulation and trabeculectomy. Intravitreal injection of bevacizumab (IVB) results in a substantial decrease in bleeding from the retinal vessels or new vessels during a standard vitrectomy. IVB has also been reported to be effective for inducing the regression of new vessels in proliferative diabetic retinopathy. The use of bevacizumab in stage 4 or 5 retinopath of prematurity (ROP) is to reduce the plus sign to help reduce hemorrhage during the subsequent vitrectomy. Some authors reported cases of resolution of stage 4A ROP after bevacizumab injection. This special issue of anti-VEGF agents comprises …