Pharmacovigilance in Intraocular Antiangiogenic Therapy

Marianne L Shahsuvaryan


Context: Currently several antiangiogenic agents  are being widely and successfully used for the treatment of eye diseases like neovascular macular degeneration, retinal vein occlusion and diabetic macular edema. The discovery of anti-VEGF (Vascular endothelial growth factor) agents has revolutionized the treatment of these conditions. Ophthalmology has witnessed an explosion in the number of intravitreal injections delivered to patients over the past 10 years, driven in large part by the introduction and rapid incorporation of therapy with anti-VEGF agents.

Objective: Taking into consideration that VEGF plays an important role not only in the pathophysiology of several sight-threatening retinal disorders such as age-related macular degeneration, retinal vein occlusion, diabetic macular edema and proliferative diabetic retinopathy, but also in the physiology of the eye, and that more data are becoming available in intraocular antiangiogenic therapy,  chemical compound-related ocular side effects across multiple antiangiogenic agents should be analyzed critically.

Methods: A comprehensive literature search was conducted on Medline, PubMed, and Google Scholar databases in February 2015. Search temporal limits included articles published from 2005 to 2015 with the purpose of providing the most recent evidence. Studies were queried using the following keywords in various combinations: antiangiogenics in eye diseases, intravitreal pharmacotherapy by anti-VEGF, adverse effects, potential ocular  hazards, bevacizumab, pegaptanib sodium, ranibizumab, aflibercept. The articles of high or medium clinical relevance were selected for review.

Results: Almost uniformly all trial evaluating ocular safety of antiangiogenic agents reveal the serious side effects including geographic atrophy, pigment epithelial tear, ocular hemorrhage despite the fact that the incidence is low. Ocular safety concern in intraocular pharmacotherapy by anti-angiogenic agents  has a strong body of clinical evidence, resulting in  plenty of peer reviewed clinical articles.

Conclusion: Currently available findings obviate the need to raise awareness about  chemical compound-related ocular side effects in patients with eye diseases treated by antiangiogenic agents. Hopefully that noninvasive therapeutic options will become available soon.

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