MedComm-Future Medicine | Antiangiogenic therapy for ocular diseases: Current status and challenges


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Ocular neovascular diseases. (A) Normal eye structure. (B) Normal retinal structure of a representative area of a normal eye (the rectangular area in A). (C) In wet age-related macular degeneration (wAMD), neovessels originate from the choroid and grow into the subretinal space and can lead to vision loss when uncontrolled. (D) In retinopathy of prematurity (ROP), retinal neovessels grow into the vitreous and are the major cause of blindness in newborn infants. (E) In corneal neovascularization, new blood vessels grow from the limbal vascular plexus into the otherwise avascular cornea, resulting in impaired corneal clarity and vision acuity. GCL, ganglion cell layer; INL, inner nuclear layer; IPL, inner plexiform layer; IS/OS, inner and outer segments; ONL, outer nuclear layer; OPL, outer plexiform layer; RPE, retinal pigment epithelium.

Angiogenesis is the process of new blood vessel growth from pre-existing ones involving vascular endothelial cell activation, proliferation, migration, and tube formation. The vascular endothelial growth factor A (VEGF-A) is known to be a key factor that promotes angiogenesis. Pathological angiogenesis is a key and common feature of numerous ocular neovascular diseases, such as wet age-related macular degeneration, diabetic retinopathy, retinopathy of prematurity, retinal vein occlusion, and corneal neovascularization. Although anti-VEGF treatment has been a great success for the treatment of such ocular neovascular diseases, many challenges exist, such as limited efficacy, unresponsiveness in many patients, drug resistance, treatment burden due to repeated intravitreous injection, all of which incent much effort and enthusiasm to find new and better treatment for ocular neovascular diseases. In recent years, new antiangiogenic drug, targets and drug delivery methods have been developed. This perspective discusses the status of currently available therapies, challenges, opportunities, and potential new directions toward better therapies for ocular neovascular diseases.

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