Abstract

The advent of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management of retinal vascular and neovascular diseases over the past two decades. Diseases that once led inevitably to severe visual loss, including neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusion (RVO), myopic choroidal neovascularization (mCNV), and retinopathy of prematurity (ROP), can now be effectively controlled with repeated intravitreal pharmacotherapy. The evolution from first-generation agents such as pegaptanib and bevacizumab to newer molecules including aflibercept, brolucizumab, faricimab, and port delivery systems has transformed treatment paradigms toward longer durability and personalized regimens. Despite remarkable success, challenges remain regarding treatment burden, real-world adherence, tachyphylaxis, cost, systemic safety, and inequitable access in developing countries. Emerging innovations including bispecific antibodies, gene therapy, sustained-release implants, biosimilars, artificial intelligence-guided retreatment, and home monitoring technologies are reshaping the future landscape of retinal therapeutics.

Keywords

Anti-VEGF, intravitreal injections, age-related macular degeneration, diabetic macular edema, retinal vein occlusion, faricimab, aflibercept, retina