TY - JOUR
T1 - Vascular endothelial growth factor inhibition in uveitis
T2 - A systematic review
AU - Gulati, Nishi
AU - Forooghian, Farzin
AU - Lieberman, Ronni
AU - Jabs, Douglas A.
PY - 2011/2
Y1 - 2011/2
N2 - Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of uveitic complications such as cystoid macular oedema (CMO), choroidal neovasularisation (CNV) and retinal neovascularisation (RNV). The use of intravitreal anti-VEGF therapies, namely bevacizumab and ranibizumab, has recently been described in the treatment of these complications. Evidence describing the use of intravitreal anti-VEGF therapy for these complications consists of case reports and case series, most of which are retrospective and have limitations in design and analysis. As such, the current level of evidence supporting the use of intravitreal anti-VEGF therapy for these complications of uveitis would be rated as very low. Furthermore, blockage of VEGF has not been shown to have an anti-inflammatory effect. Thus, treatment of the underlying inflammatory disease should play a central role in the management of uveitic CMO, CNV and RNV. A two-pronged treatment regimen that focuses on achieving disease quiescence through the use of corticosteroids and/or immunosuppressive agents, while treating complications that arise despite adequate disease quiescence with intravitreal anti-VEGF agents, may be useful. However, further data from prospective controlled trials are needed before the therapeutic role of anti-VEGF therapy in the uveitis treatment regimen can be fully determined.
AB - Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of uveitic complications such as cystoid macular oedema (CMO), choroidal neovasularisation (CNV) and retinal neovascularisation (RNV). The use of intravitreal anti-VEGF therapies, namely bevacizumab and ranibizumab, has recently been described in the treatment of these complications. Evidence describing the use of intravitreal anti-VEGF therapy for these complications consists of case reports and case series, most of which are retrospective and have limitations in design and analysis. As such, the current level of evidence supporting the use of intravitreal anti-VEGF therapy for these complications of uveitis would be rated as very low. Furthermore, blockage of VEGF has not been shown to have an anti-inflammatory effect. Thus, treatment of the underlying inflammatory disease should play a central role in the management of uveitic CMO, CNV and RNV. A two-pronged treatment regimen that focuses on achieving disease quiescence through the use of corticosteroids and/or immunosuppressive agents, while treating complications that arise despite adequate disease quiescence with intravitreal anti-VEGF agents, may be useful. However, further data from prospective controlled trials are needed before the therapeutic role of anti-VEGF therapy in the uveitis treatment regimen can be fully determined.
UR - http://www.scopus.com/inward/record.url?scp=79251497357&partnerID=8YFLogxK
U2 - 10.1136/bjo.2009.177279
DO - 10.1136/bjo.2009.177279
M3 - Review article
C2 - 20494915
AN - SCOPUS:79251497357
SN - 0007-1161
VL - 95
SP - 162
EP - 165
JO - British Journal of Ophthalmology
JF - British Journal of Ophthalmology
IS - 2
ER -