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Diabetic retinopathy is one of the withering disorders that has been making the lives of patients miserable. Arising as a result of chronic high blood sugar levels in diabetes patients, retinopathy has become a major reason causing permanent blindness, retinal detachment, vitreous humor, rage, or glaucoma among patients. Angiogenesis being the major culprit behind the development of this condition is the growth of new blood vessels from the earlier ones existing. The abnormal growth and poor development of blood vessels also lead to aggravation of the conditions, with vascular endothelial growth factor (VEGF) playing a major role in the process. Various anti-angiogenic therapies or anti-VEGF therapies are being explored for the treatment of this condition. 4 widely explored drugs being-Bevacizumab, pegaptanib sodium, ranibizumab, and aflibercept. The review article tries to summarize studies illustrating the efficacy of these drugs in the treatment of diabetic retinopathy along with some of the herbal therapeutic paradigms displaying anti-angiogenic action that is being used to treat this condition. [ABSTRACT FROM AUTHOR]

Anti-vascular endothelial growth factor (anti-VEGF) crunch syndrome describes the progression to tractional retinal detachment following intravitreal anti-VEGF therapy in an eye with proliferative diabetic retinopathy. We reviewed the literature on the anti-VEGF crunch using the PubMed and Cochrane databases. Anti-VEGF crunch typically manifests as sudden vision loss in the affected eye between 1 and 6 weeks following intravitreal anti-VEGF injection, with a mean onset of 13 days. Risk factors for crunch development include the use of a higher anti-VEGF dose and increased severity of diabetic retinopathy with fibrosis. Our review found that intravitreal anti-VEGF, in particular bevacizumab, should be used with caution when treating patients with severe proliferative diabetic retinopathy and pre-existing intraocular fibrosis. In patients where anti-VEGF is used before a planned vitrectomy, we recommend close monitoring for crunch symptoms and proceeding promptly with surgery if there is new or progression of tractional retinal detachment. For eyes with minimal preexisting traction that develop crunch after anti-VEGF treatment, surgeons should proceed to vitrectomy within 7 days. The existing literature on the anti-VEGF crunch is limited by heterogeneity in the way crunch is documented and characterized and the presence of panretinal photocoagulation as a confounding factor. Because of these methodological flaws, the relative frequency of the anti-VEGF crunch cannot be accurately estimated. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a systematic review with network meta‐analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti‐vascular endothelial growth factor (VEGF) treatment alone or in combination with PRP, for proliferative diabetic retinopathy (PDR). Methods: PubMed, Medline and Embase databases were searched for RCTs comparing PRP versus intravitreal anti‐VEGF therapy and/or combined PRP and intravitreal anti‐VEGF for PDR. The primary outcome measures were the mean best corrected visual acuity (BCVA) change and the regression of neovascularization. Mean change of central macular thickness (CMT), the subgroup analyses of patients without diabetic macular oedema (DME) and the rate of vitreous haemorrhage and vitrectomy were secondary outcomes. Frequentist NMAs were performed. Results: Twelve RCTs were included. For the 12‐month mean BCVA change, NMA showed a better visual outcome in both the anti‐VEGF group and combined group compared to PRP [anti‐VEGF vs PRP, mean difference (MD) = 3.42; standard error (SE) = 1.5; combined vs PRP, MD = 3.92; SE = 1.65], with no difference between combined group and anti‐VEGF (MD = −0.50; SE = 1.87). No difference in neovascularization regression was found between PRP and anti‐VEGF alone or in combination with PRP, but there was significant inconsistency (p = 0.016). Subgroup analyses in patients without DME yielded no difference for the 12‐month visual outcome between the three interventions, but with significant inconsistency (p = 0.005). Conclusion: This NMA showed limited evidence of comparable efficacy in terms of neovascularization regression between PRP and anti‐VEGF therapy alone or in combination with PRP, but better visual outcomes were associated with anti‐VEGF use. Intravitreal anti‐VEGF therapy could be a valid therapeutic option in association with PRP. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of topical instillation of pegaptanib sodium upon inflammatory angiogenesis induced in the rabbit cornea by alkaline cauterization. Methods: Inflammatory angiogenesis was induced by alkaline (sodium hydroxide) cauterization in the corneas of 29 male New Zealand rabbits. The animals were divided into 4 groups: a control group treated with 0.5% carboxymethylcellulose sodium eye drops, a group treated with 1.0% prednisolone acetate eye drops, a group treated with 0.5% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium, and a group treated with 1.0% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium. After cauterization, eye drops were administered every 12 hours for 21 days. The animals were evaluated every 3 days after cauterization, and the newly formed vessels were quantified from photographs. The treatment effectiveness was analyzed with 3 parameters of antiangiogenic response: neovascularization area (NA), total vascular length (TVL), and number of blood vessels (BVN). Results: Average NA, TVL, and BVN values were significantly higher in both pegaptanib groups than in the prednisolone group. A nonstatistically significant reduction in parameters on days 18 and 21 was the minimum achieved in both pegaptanib groups. The efficacy of the treatments in relation to the control was significantly greater in the prednisolone group than in the 0.5% pegaptanib group or the 1.0% pegaptanib group (P < 0.001). Conclusion: Topical instillation of 0.5% and 1.0% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium had no inhibitory effect on corneal neovascularization in this rabbit model. [ABSTRACT FROM AUTHOR]

Background: Intraocular inflammation is an uncommon but potentially vision-threatening adverse event related to anti-VEGF therapy. This is of increasing importance given both the volume of injections performed, as well as the increased prevalence of inflammation seen with newer anti-VEGF agents. Brolucizumab, the newest anti-VEGF agent, has been associated with an inflammatory retinal vasculitis and the underlying mechanism is unclear. Reviewing potential mechanisms and clinical differences of intraocular inflammation may assist clinicians and scientists in reducing the risk of these events in the future. Observations: Two types of inflammation are seen with intravitreal injections, acute onset sterile inflammation and delayed onset inflammatory vasculitis. Acute onset inflammation can be subcategorized into subclinical anterior chamber inflammation and sterile uveitis/endophthalmitis. Subclinical anterior chamber inflammation can occur at rates as high as 19% after intravitreal anti-VEGF injection. Rates of sterile uveitis/endophthalmitis range from 0.05% to 4.4% depending on the anti-VEGF agent. Inflammatory vasculitis is only associated with brolucizumab and occurred in 3.3% of injections according to the post hoc review of the HAWK/HARRIER data. In addition, silicone oil from syringes can induce immunogenic protein aggregates. Agitation of the syringe, freeze thawing, shipping and improper storage prior to injection may increase the amount of silicone oil released from the syringe. Conclusion: The main factors which play a role in intraocular inflammation after anti-VEGF injection can be divided into three causes: patient-specific, medication-specific and delivery-specific. The majority of clinically significant inflammation seen after intravitreal injection is an acute onset inflammatory response with most patients recovering baseline VA in 3–5 weeks. The presence of pain, hypopyon, severe anterior chamber reaction, hyperemia and significant vision loss may help distinguish infectious from non-infectious etiologies of post injection inflammation. Avoiding temperature fluctuation, mechanical shock, agitation during transport and handling of syringes/drugs, and the use of SO-free syringes may help minimize intraocular inflammation. While a definitive mechanism has not yet been established, current knowledge of the clinical presentation and vitreous histopathology of brolucizumab-retinal vasculitis favors an auto-immune type IV hypersensitivity reaction. [ABSTRACT FROM AUTHOR]

چکیده آپتامرها توالی ­های کوتاه تک رشته ­ای اسید نوکلئیکی (DNA یا RNA) یا پپتیدی با ساختار سه بعدی ویژه­ای هستند که قادرند با اختصاصیت و تمایل بالایی به اهداف خود متصل شوند. اندازه کوچک، فرایند تولید سریع و ارزان، ایمنی ­زایی اندک و پایداری بالا، آن ها را به مولکول­ های جذابی در برخی زمینه­های پژوهشی به ویژه در طراحی مسیر­های تشخیصی و درمانی جدید تبدیل کرده است. در این مقاله مروری، فرآیند تولید آپتامر­های اسید نوکلئیکی، مزایا و معایب آن ها در مقایسه با آنتی­ بادی ­ها و پتانسیل­ های کاربردیشان در پزشکی بحث می ­شود. همچنین محدودیت های آپتامرها و راه­کارهای غلبه بر آن نیز مورد بررسی قرار می­ گیرد.

Given the poor prognosis of proliferative diabetic retinopathy(PDR), the morbidity of PDR has also increased recent years. Modern surgery has undergone a very impressive development over the last 10a due to the evolution of methods, techniques and extension of surgical indications. In this article, we will review the current choices of the surgery time, perioperative managements, as well as the methods of the vitrectomy.

Over the last decade, intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have been increasingly used in the management of various retinal diseases, especially diabetic macular oedema. Diabetic macular oedema is one of the leading causes of legal blindness among patients with diabetic retinopathy, meaning these patients are eligible for associated medical benefits. It is essential that diabetic macular oedema is managed with an effective and safe treatment for good long-term prognosis. Over the past decade, focal/grid laser photocoagulation has been the gold standard treatment. However, evidence supporting the superior clinical benefits and relative safety of anti-VEGF agents has driven a recent shift in treatment paradigm, favouring anti-VEGF over laser treatment. Previous studies involving systemic anti-VEGF treatment in cancers have identified an associated increased risk of arteriothrombotic events, such as myocardial infarction and stroke, which are potentially fatal. Hence, it is important to evaluate whether such risks, which will significantly alter the safety profile, persist with intravitreal administration. A comprehensive literature review was performed and concluded that no significant increase in risk of ocular or non-ocular adverse events, particularly arteriothrombotic events, were associated with anti-VEGF agents, predicting an overall favourable safety profile. A summary of some of the possible adverse events recorded in the various studies, albeit at relatively low rates, are also included. Additionally, it is briefly discussed how real-world concerns of cost and affordability can influence treatment choice, thereby affecting how clinical evidence is transferred into practice.

Diabetic macular oedema (DMO) is a common ocular problem among patients with diabetic retinopathy, which is sight-threatening and leads to blindness. The gold standard treatment for DMO had been focal/grid laser photocoagulation that achieved stabilisation of disease progression. However, newer pharmacological treatment options have gradually been favoured, as studies demonstrate their superior efficacy with regard to significant visual improvements. In particular, use of anti-vascular endothelial growth factor (anti-VEGF) has become very popular, with promising evidence emerging from numerous trials regarding efficacy and safety. Based on the 2014 American Society of Retina Specialists (ASRS) Preferences and Trends survey, the current preferred first-line therapy for DMO is in fact an anti-VEGF agent. Studies have shown that VEGF plays a critical role in both the angiogenesis and inflammation processes that occur during development of DMO. Hence, this allows anti-VEGF agents to specifically target and treat the underlying pathology, signifying its importance, and possibly accounting for its efficacy. We evaluate the available literature documenting the efficacy of anti-VEGF treatment in DMO. A key clinical finding was that anti-VEGF, as a drug class, achieved superior resolution of macular oedema and visual improvements that were consistently sustainable over 3 years, with some evidence pointing towards 5-year sustainability too. Hence, with intravitreal anti-VEGF treatments increasingly available, better long-term prognosis and, crucially, reduced likelihood of progression to blindness can be expected in patients with DMO.

The discovery of antivascular endothelial growth factor medications has resulted in a substantial change in diabetic retinopathy treatment. The most common cause of diabetic retinopathy blindness is Diabetic Macular Edema. The pathophysiology of Diabetic Macular Edema is thought to include the well-known pro-angiogenic and pro-permeability factor vascular endothelial growth factor. Over the past decade, drugs that impede the functions of vascular endothelial growth factors have established themselves as a standard-of-care treatment for a range of ocular ailments and improved patients' clinical results with diabetic retinopathy and Diabetic Macular Edema, and their frequency has grown exponentially with the introduction of these agents Pegaptanib, Ranibizumab, and Aflibercept which are approved for ophthalmic indications, while Bevacizumab is used off-label. These medications delivered intravitreally have halted the vascular development of diabetic retinopathy. Various randomized trials have proven that antivascular endothelial growth factor medication is safe and effective in preserving vision. Following an extensive period of preclinical development aimed at enhancing and defining its biological impacts, these drugs were shown in clinical trials to be effective in treating diabetic retinopathy and other ophthalmic conditions. Data from various sources suggest that Pegaptanib, Ranibizumab, and Aflibercept are costly, while Bevacizumab is cost-effective, and in low and middle-income nations, it is thus a desirable therapy choice. However, issues with compounding, counterfeiting, and off-label usage restrict its availability in many nations. The pharmacology, pharmacokinetics, pharmacodynamics, adverse effects, and contraindications of antivascular endothelial growth factor agents are discussed, and the results of clinical trials evaluating their efficacy are summarized., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: Pegaptanib might be a promising anti‐tumour drug targeting VEGF to inhibit tumour vascular endothelial cell proliferation. However, the poor biostability limited its application. In this study, we took tetrahedron DNA nanostructures (TDNs) as drug nanocarrier for pegaptanib to explore the potent anti‐angiogenesis and anti‐tumour activity of this drug delivery system. Materials and methods: The successful synthesis of TDNs and pegaptanib‐TDNs was determined by 8% polyacrylamide gel electrophoresis (PAGE), capillary electrophoresis and dynamic light scattering (DLS). The cytotoxicity of pegaptanib alone and pegaptanib‐TDNs on HUVECs and Cal27 was evaluated by the cell count kit‐8 (CCK‐8) assay. The effect of pegaptanib and pegaptanib‐TDNs on proliferation, migration and tube formation of HUVECs induced by VEGF was examined by CCK‐8 assay, wound healing assay and tubule formation experiment. The cell binding capacity and serum stability were detected by flow cytometry and PAGE, respectively. Results: Pegaptanib‐TDNs had stronger killing ability than pegaptanib alone, and the inhibiting effect was in a concentration‐dependent manner. What's more, pegaptanib‐loaded TDNs could effectively enhance the ability of pegaptanib to inhibit proliferation, migration and tube formation of HUVECs induced by VEGF. These might attribute to the stronger binding affinity to the cell membrane and greater serum stability of pegaptanib‐TDNs. Conclusions: These results suggested that pegaptanib‐TDNs might be a novel strategy to improve anti‐angiogenesis and anti‐tumour ability of pegaptanib. [ABSTRACT FROM AUTHOR]

The 'golden years' are much less so if you lose your central vision to neovascular age-related macular degeneration (AMD). Approximately 15 out of 1000 individuals over age 75 will have [...]

Over the recent years, retina specialists have enjoyed significant improvements in the surgical management of proliferative diabetic retinopathy including improved preoperative planning, vitreoretinal instrumentation and new surgical maneuvers. In this review, we present new tips and tricks such as preoperative pharmacotherapy approaches including pegaptanib injection and biodegradable dexamethasone implantation, bimanual vitrectomy techniques and the concept of mixing small gauges as well as valved cannulas and intraoperative optical coherence tomography. With advanced surgical planning and sophisticated operative maneuvers tailored to the individual patient, excellent outcomes can be achieved even in severe cases of diabetic tractional detachment.

Christine A Kiire, Rupal Morjaria, Anna Rudenko, Alexina Fantato, Lewis Smith, Amy Smith, Victor Chong Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Purpose: Pegaptanib has been shown to be effective in treating diabetic macular edema (DME). In the original Phase II/III trial, however, patients with macular ischemia were excluded. In this study, we treated patients with ischemic DME. Methods: Macular ischemia was defined as a 30% increase in the area of the foveal avascular zone (FAZ) at 45 seconds on fundus fluorescein angiography. In addition, the participants had diffuse foveal-involving DME with a central subfield thickness (CST) of >300 µm on spectral-domain optical coherence tomography. Five intravitreal pegaptanib injections were given 6 weeks apart. The final study visit was 6 weeks after the fifth injection. The primary outcome was change in the size of FAZ. Secondary outcomes were change in best-corrected visual acuity (BCVA) and the change in CST. Results: Thirty participants were enrolled. Three were unable to complete the full course of treatment. Their outcomes were carried forward for the first part of this analysis. There was no statistically significant change in the mean size of the FAZ from baseline to the final visit. Subclassifying participants as those with minimal/moderate ischemia (16 participants, FAZ area 1,000 pixels) also showed no statistically significant change in the mean area of the FAZ. On average, BCVA increased and CST decreased from baseline to the final visit, but these changes were not statistically significant. Using per protocol analysis on those participants who completed the full course of treatment, the mean BCVA increased from 49.2 to 53.9 letters (P=0.046). Conclusion: In this study, intravitreal injection of pegaptanib did not significantly alter the size of the FAZ in participants with varying degrees of ischemic DME. There was, however, a significant improvement in mean BCVA in those who completed the treatment course. Keywords: macular ischemia, anti-VEGF, pegaptanib, diabetic macular edema

Purpose. To evaluate the results of intravitreal use of Pegaptanib in patients with exudative age-related macular degeneration (AMD). Material end methods. Our study includes 77 patients with exudative AMD, who received 9 injections of Pegaptanib 0.3mg with 6-weeks intervals between them. So the primary treatment lasted one year. During and after the treatment these patients underwent fluorescent angiography (FAG), optical coherence tomography (OCT), fundus photography and best corrected visual acuity (BCVA) examination. According to the results of these examinations a decision about a further treatment, whether it was necessary, was taken. Results. By the end of our 2-year study 38 patients after therapy with Pegaptanib had complete obliteration of the choroidal neovascularization (CNV), 19 patients were switched to Ranibizumab, one patient underwent photodynamic therapy with Visudyne, 14 patients had severe progression of AMD, when there was no sense in further treatment, 2 patients dropped out the study because of cerebral insult, 3 patients refused of any further treatment, in spite of persisting exudative activity of the CNV after the primary treatment. Conclusion. Intravitreal аpplication of Pegaptanib is a relatively effective treatment option of exudative AMD as BCVA was stabilized or improved in 55.8% of patients, macular edema decreased in 67.5% of patients and neovascular membrane was obliterated in 49.35% of patients.

VEGF-mediated angiogenesis is a key mechanism of pathologic retinal neovascularization in the proliferative diabetic retinopathy (PDR). Therefore, the anti-VEGF therapy can be considered as a perspective approach for the treatment of this complication. In patients with the PDR the combination of anti-VEGF agents with a panretinal photocoagulation prevents a decrease of visual acuity, a development of macular edema and, according to some data, enhances a neovascularization regression. In patients with vitreous hemorrhages the anti-VEGF agents injection before the vitrectomy reduces the incidence of recurrent hemorrhages in intra- and postoperative period. In eyes with PDR complicated with neovascular glaucoma the intravitreal bevacizumab injection leads to a regression of iris and anterior angle vascularization. Currently, the most frequent data exist in the use of bevacizumab, the effects of ranibizumab and pegaptanib are investigated in a lesser extent, researches of aflibercept have been initiated recently. Future studies are required to estimate the necessary duration and effectiveness predictors of anti-VEGF therapy, as well as the best combinations of anti-VEGF agents with other treatment modalities.

Byline: Vinu. Jose, Swetha. Radhakrishna, Parag. Pipalava, Inderjeet. Singh Vascular endothelial growth factor (VEGF) inhibitors, ranibizumab, aflibercept, and pegaptanib are approved treatments for certain eye diseases that occurs especially in [...]

Diabetic macular edema (DME) is a common complication associated with the loss of visual acuity in diabetic patients. Intravitreal injections of vascular endothelium growth factor (VEGF) inhibitors (anti-VEGF therapy) have been proposed recently as a new treatment option for patients with DME. In this review we summarized results of randomized clinical trials of VEGF inhibitors in DME patients. The results indicate that all studied inhibitors (ranibizumab, bevacizumab, pegaptanib and aflibersept) reduce the retinal thickness and improve of visual acuity in DME when are used as a monotherapy or in combination with the laser treatment. Optimal course duration and effectiveness predictors of anti-VEGF therapy in DME should be elucidate in the future studies.

AIM:To compare the efficacies of subconjunctival bevacizumab, ranibizumab, and pegaptanib sodium injections for the inhibition of corneal neovascularization in an experimental rat model.METHODS:Sixteen corneas of 16 rats were chemically cauterized and randomized into four groups:bevacizumab group that treated with 0.05mL/1.25mg bevacizumab, ranibizumab group that treated with 0.05mL/0.5mg ranibizumab, pegaptanib group that treated with 0.05mL/0.15mg pegaptanib sodium, and control group that treated with 0.05mL saline solution. Digital photographs of the corneas were taken and analyzed using an image analysis software program. All corneas were excised and examined histologically on the 15th day.RESULTS: Each treatment group had significantly less neovascularized corneal areas and fewer blood vessels than the control group (all P0.05). CONCLUSION:Subconjunctival bevacizumab, ranibizumab, and pegaptanib sodium were effective with no corneal epitheliopathy for inhibiting corneal neovascularization after corneal burn in rats. Bevacizumab was more effective than ranibizumab and pegaptanib sodium

ABSTRACT Purpose. To evaluate the results of intravitreal use of Pegaptanib in patients with exudative age-related macular degeneration (AMD). Material end methods. Our study includes 77 patients with exudative AMD, who received 9 injections of Pegaptanib 0.3mg with 6-weeks intervals between them. So the primary treatment lasted one year. During and after the treatment these patients underwent fluorescent angiography (FAG), optical coherence tomography (OCT), fundus photography and best corrected visual acuity (BCVA) examination. According to the results of these examinations a decision about a further treatment, whether it was necessary, was taken. Results. By the end of our 2-year study 38 patients after therapy with Pegaptanib had complete obliteration of the choroidal neovascularization (CNV), 19 patients were switched to Ranibizumab, one patient underwent photodynamic therapy with Visudyne, 14 patients had severe progression of AMD, when there was no sense in further treatment, 2 patients dropped out the study because of cerebral insult, 3 patients refused of any further treatment, in spite of persisting exudative activity of the CNV after the primary treatment. Conclusion. Intravitreal аpplication of Pegaptanib is a relatively effective treatment option of exudative AMD as BCVA was stabilized or improved in 55.8% of patients, macular edema decreased in 67.5% of patients and neovascular membrane was obliterated in 49.35% of patients.

Purpose: To describe the patient’s allergic response to anti–vascular endothelial growth factor drugs after receiving intravitreal bevacizumab for choroidal neovascularization. Methods: Clinical case report. Results: Formal allergy evaluation revealed hypersensitivity to bevacizumab and ranibizumab, but not to pegaptanib or aflibercept. Conclusion: Bevacizumab and ranibizumab are derivatives of murine monoclonal antibodies, whereas pegaptanib is an aptamer and aflibercept is a fusion protein of human origin. These chemical origins may allow patients to receive pegaptanib or aflibercept despite having allergy to bevacizumab or ranibizumab. [ABSTRACT FROM AUTHOR]

Tushar M Ranchod, Stuart L FineScheie Eye Institute, Department, of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USAAbstract: Diabetic macular edema (DME) is a leading cause of vision loss in older Americans. Thermal laser treatment remains the mainstay of treatment for DME. Recently, alternative primary treatments for DME have been evaluated. These treatments include intravitreal injections of steroids as well as pharmaceuticals containing antibodies against vascular endothelial growth factor (VEGF). Surgical treatment has been shown to be appropriate in selected cases. We review the evidence and scientific rationale for various primary treatment options in patients with DME. Regular and timely ophthalmologic evaluation remains crucial to recognition and treatment of macular edema in diabetic patients. Keywords: diabetic macular edema, vision loss, diabetes mellitus

In the last few years anti-vascular endothelial growth factor (VEGF) therapy has changed the paradigm in the treatment of neovascular age-related macular degeneration (ARMD). Besides, its potential use in the treatment of diabetic retinopathy and other possible proliferative vascular disorders has also shown promise. Clinical trial results have shown tremendous beneficial effect of ranibizumab in ARMD. Off-label use of bevacizumab has also shown similar benefit but long-term and clinical trial results do not exist. Some of the potential questions in the use of anti-VEGF are recurring cost, possible long-term effect on physiological function of VEGF and determination of endpoint of treatment. Overall, the use of anti-VEGF therapy in ocular angiogenesis has proven to be beneficial at least now.

Pegaptanib sodium (Macugen) is a selective RNA aptamer that inhibits vascular endothelial growth factor (VEGF) 165 , the VEGF isoform primarily responsible for pathologic ocular neovascularization and vascular permeability, while sparing the physiological isoform VEGF 121 . After more than 10 years in development and preclinical study, pegaptanib was shown in clinical trials to be effective in treating choroidal neovascularization associated with age-related macular degeneration. Its excellent ocular and systemic safety profile has also been confirmed in patients receiving up to three years of therapy. Early, well-controlled studies further suggest that pegaptanib may provide therapeutic benefit for patients with diabetic macular edema, proliferative diabetic retinopathy and retinal vein occlusion. Notably, pegaptanib was the first available aptamer approved for therapeutic use in humans and the first VEGF inhibitor available for the treatment of ocular vascular diseases.

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For years, the standard of care for branch-retinal-vein-occlusion-associated macular edema was initial observation followed by grid-pattern laser photocoagulation for persistent edema. Newer pharmacologic options have revolutionized the management of branch-retinal-vein-occlusion-associated macular edema, and the visual outcomes of these eyes are better than ever. However, a variety of available treatment options including intravitreal corticosteroids and intravitreal antivascular endothelial growth factor agents have established novel challenges with regard to appropriate drug selection. This review summarizes the available clinical studies with special emphasis on the comparison of intravitreal aflibercept with ranibizumab, bevacizumab, and steroid agents. [ABSTRACT FROM AUTHOR]