Choroidal Neovascularization Medication

Updated: Feb 10, 2017
  • Author: Lihteh Wu, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Medication

Medication Summary

Decreased vision with choroidal neovascularization is caused in part by the accumulation of subretinal fluid secondary to increased vascular permeability. Anti-VEGF agents arrest the neovascularization and reduce vision loss.

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Anti-VEGF therapy

Class Summary

Reduces risk of visual loss similar to that seen with PDT.

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Photosensitizers for photodynamic therapy

Class Summary

Reduction of leakage from abnormal, neovascular vessels, resulting in reduced visual loss.

Verteporfin (Visudyne)

A benzoporphyrin derivative monoacid (BPD-MA), consists of equally active isomers BPD-MAC and BPD-MAD, which can be activated by low-intensity, nonthermal light of 689-nm wavelength. After activation with light and in presence of oxygen, verteporfin forms cytotoxic oxygen free radicals and singlet oxygen. Singlet oxygen causes damage to biological structures within range of diffusion. This leads to local vascular occlusion, cell damage, and cell death. In plasma, verteporfin is transported primarily by low-density lipoproteins (LDL). Tumor and neovascular endothelial cells have increased specificity and uptake of verteporfin because of their high expression of LDL receptors. Effect can be enhanced by use of liposomal formulation.

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Ophthalmics, VEGF Inhibitors

Aflibercept intravitreal (Eylea)

A recombinant fusion protein consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to the Fc portion of human IgG1. Inhibits all VEFG isoforms and placental growth factor.

Pegaptanib (Macugen)

Selective VEGF antagonist that promotes vision stability and reduces visual acuity loss and progression to legal blindness. VEGF causes angiogenesis and increases vascular permeability and inflammation, all of which contribute to neovascularization in age-related wet macular degeneration.

Ranibizumab (Lucentis)

Ranibizumab is a recombinant monoclonal antibody Fab designed to bind and inhibit VEGF-A, a protein that is believed to play a critical role in the formation of new blood vessels of exudative ARMD. First approved treatment with visual improvement for exudative ARMD.

Bevacizumab (Avastin)

A nonspecific monoclonal anti-VEGF. Off-label drug with apparent similar efficacy of ranibizumab.

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