The Injectables: What, When, and Which One?

ABSTRACT

@#Vascular endothelial growth factor (VEGF) and inflammation. VEGF-A circulates normally in the body and is essential in endothelial cell growth. In the pathological state in the eye, hypoxia increases VEGF-A, promotes growth of neovascularization and accelerates the breakdown of blood-retinal barrier and build-up of fluid in or under the neurosensory retina and retinal pigment epithelium (RPE). It has 6 isoforms; the predominant isoform (most common of which) is VEGF 165 and is most linked to neovascularization in the eye. VEGF-A provided the rationale for targeted drug development. Anti-VEGF drugs are anti-angiogenic, anti-inflammatory, antifibrotic, and anti-permeable. The rationale for the use of steroids to treat macular edema is related to their ability to reduce capillary permeability, to inhibit the expression of VEGF gene, and to inhibit the metabolic pathway of VEGF.