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.

Class Summary

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

Class Summary

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

Verteporfin (Visudyne)

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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.

Aflibercept intravitreal (Eylea)

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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)

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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)

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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)

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

Brolucizumab intravitreal (Brolucizumab-dbll, Beovu)

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Brolucizumab is a single-chain antibody fragment against all VEGF isoforms.

Faricimab (Faricimab-svoa, Vabysmo)

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Faricimab is a monoclonal antibody that targets both VEGF and Ang-2 (angiopoietin 2)

Questions

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Author

Lihteh Wu, MD Ophthalmologist, Costa Rica Vitreo and Retina Macular Associates

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Bayer; Quantel Medical, Roche<br/>Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical, Roche.

Coauthor(s)

Dhariana Acón, MD Ophthalmologist, Caja Costarricense Seguro Social, Hospital de Guapiles, Costa Rica

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

Brian A Phillpotts, MD Ophthalmologist, St Luke's Cataract and Laser Institute

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Association of University Professors of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

Choroidal Neovascularization (CNV) Medication

Medication Summary

Anti-VEGF therapy

Class Summary

Photosensitizers for photodynamic therapy

Class Summary

Verteporfin (Visudyne)

Verteporfin (Visudyne)

Ophthalmics, VEGF Inhibitors

Aflibercept intravitreal (Eylea)

Aflibercept intravitreal (Eylea)

Pegaptanib (Macugen)

Pegaptanib (Macugen)

Ranibizumab (Lucentis)

Ranibizumab (Lucentis)

Bevacizumab (Avastin)

Bevacizumab (Avastin)

Brolucizumab intravitreal (Brolucizumab-dbll, Beovu)

Brolucizumab intravitreal (Brolucizumab-dbll, Beovu)

Dual anti-VEGF and anti-angiopoietin 2

Ophthalmics, ANG-2 Inhibitors

Faricimab (Faricimab-svoa, Vabysmo)

Faricimab (Faricimab-svoa, Vabysmo)

Choroidal Neovascularization (CNV) Medication

Medication Summary

Anti-VEGF therapy

Class Summary

Photosensitizers for photodynamic therapy

Class Summary

Verteporfin (Visudyne)

Verteporfin (Visudyne)

Ophthalmics, VEGF Inhibitors

Aflibercept intravitreal (Eylea)

Aflibercept intravitreal (Eylea)

Pegaptanib (Macugen)

Pegaptanib (Macugen)

Ranibizumab (Lucentis)

Ranibizumab (Lucentis)

Bevacizumab (Avastin)

Bevacizumab (Avastin)

Brolucizumab intravitreal (Brolucizumab-dbll, Beovu)

Brolucizumab intravitreal (Brolucizumab-dbll, Beovu)

Dual anti-VEGF and anti-angiopoietin 2

Ophthalmics, ANG-2 Inhibitors

Faricimab (Faricimab-svoa, Vabysmo)

Faricimab (Faricimab-svoa, Vabysmo)

References

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