Anti-angiogenesis Therapy in Diabetic Retinopathy

Abstract

Angiogenesis plays a central role in the development of diabetic retinopathy and its visually debilitating complications diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Inflammation and ischemia, which result from hyperglycemia-induced oxidative stress, are primary drivers of diabetic retinopathy and vision loss. Several chemokines and cytokines are upregulated in eyes with diabetic retinopathy, and vascular endothelial growth factor (VEGF) is pivotal to the development of DME and PDR. Three VEGF inhibitors (aflibercept, bevacizumab, and ranibizumab) and three corticosteroids (triamcinolone, dexamethasone, and fluocinolone) are commonly used to treat the retinal complications of angiogenesis. Several phase III trials that were used to obtain regulatory approvals have produced level I evidence showing that these drugs are superior to standard therapy (laser photocoagulation or observation). Research into new anti-VEGF and corticosteroid drugs and formulations, delivery routes and devices, and molecular targets, promises to provide physicians and patients with additional treatment options in the future.