VEGF and anti-VEGF therapy in ophthalmology

What it is

The ischaemic retina produces vascular endothelial growth factor (VEGF), among others, to try to re-establish blood flow for oxygenation.

VEGF then leads to two things:

1. Leakage of existing vessels, which results in macular oedema and hmgs.
2. Migration and proliferation of vascular endothelium, that is angiogenesis, which results in neovascularization.

Neovascularization is named by its site: NVD at the disc, NVE elsewhere in the retina, NVI of the iris, and NVA of the angle.

How it is treated

Anti-VEGF treatment is used for macular edema and for neovascularization. Trade names of some anti-VEGF are Avastin, leucentis and Eylea, and intravitreal ranibizumab is one of them.

It is met in several conditions:

• Macular oedema of central retinal vein occlusion.
• Macular oedema of diabetic retinopathy, and for foveal involved diabetic macular edema, where an intravitreal injection of corticosteroid is the other choice.
• Wet age-related macular degeneration.

Pan-retinal photocoagulation (PRP) works on the other arm of the problem: the peripheral ischaemic retina is destroyed with laser to stop VEGF production and treat the NV. So the summary is macular oedema for Anti-VEGF, and neovascularization for PRP.