Anti-VEGF agents dominate retinal vein occlusion-related macular edema treatment, with biosimilars and long-acting systems emerging
Background
Retinal vein occlusion (RVO) is a major cause of visual impairment, primarily due to macular edema (ME). This macular edema arises from increased vascular permeability, often driven by vascular endothelial growth factor (VEGF). While anti-VEGF agents have revolutionized treatment, the need for frequent intravitreal injections presents a significant burden for patients and healthcare systems. There is a continuous drive to optimize treatment strategies, improve patient adherence, and explore more durable and accessible options for managing RVO-ME effectively.
Study Design
This narrative review synthesized current evidence regarding the management of retinal vein occlusion-related macular edema (RVO-ME). The authors examined the evolution of treatment strategies, focusing on the established and selective roles of anti-VEGF agents, intravitreal corticosteroids, and laser photocoagulation. They also discussed the utility of diagnostic imaging modalities like Optical Coherence Tomography (OCT) and Fluorescein Angiography (FA), and explored future directions including biosimilars and long-acting drug delivery systems.
Results
The review highlights that vascular endothelial growth factor (VEGF) is a key pathogenic mediator in RVO-ME, making anti-VEGF agents the established mainstay of treatment. These agents are supported by robust evidence from randomized clinical trials and real-world studies, demonstrating significant efficacy in improving visual outcomes. Intravitreal corticosteroids play a selective role, reserved for patients with suboptimal responses to anti-VEGF therapy or those with contraindications, offering an alternative anti-inflammatory mechanism. Laser photocoagulation, once a primary treatment, now holds a very limited role in current management protocols. Optical Coherence Tomography (OCT) is central for diagnosis, monitoring treatment response, and prognostication, while Fluorescein Angiography (FA) aids in assessing retinal perfusion. Future directions emphasize the development of biosimilars to enhance accessibility and long-acting drug delivery systems to reduce injection burden and improve treatment durability.
Anti-VEGF agents are now the mainstay of treatment, supported by robust evidence from randomized clinical trials and real-world studies.
Key Findings
- Anti-VEGF agents are the established mainstay for RVO-ME due to VEGF's key pathogenic role.
- Intravitreal corticosteroids are selectively used for suboptimal anti-VEGF responses or contraindications.
- Laser photocoagulation now has a limited role in RVO-ME management.
Optical Coherence Tomography (OCT)is central for diagnosis, monitoring, and prognostication in RVO-ME.- Emerging therapies include biosimilars and long-acting delivery systems for improved accessibility and durability.
Why It Matters
This review reinforces the foundational role of anti-VEGF therapy in RVO-ME management, while clarifying the strategic integration of corticosteroids for specific patient profiles. For clinicians and patients, this means continued reliance on established anti-VEGF protocols, but also a clear understanding of when alternative or adjunctive therapies are warranted. The emphasis on emerging biosimilars and long-acting delivery systems signals a future where treatment could be more accessible and less burdensome, potentially improving adherence and long-term outcomes. While not introducing a new protocol, it underscores the ongoing evolution towards more patient-friendly and sustainable treatment paradigms for this vision-threatening condition.
retinal vein occlusion
macular edema
anti-vegf
corticosteroids
ophthalmology
review