Anti-VEGF in diabetic retinopathy and diabetic macular edema

Introduction: Anti-VEGF intravitreal injections have revolutionized the treatment of diabetic retinopathy and diabetic macular edema in particular. This review focuses on agents used in anti-VEGF treatment and documents evidence for their efficacy over laser photocoagulation in the treatment of diabetic macular edema. Areas covered: This study documents data from major clinical trials evaluating the safety and efficacy of the following anti-VEGF drugs: ranibizumab (Lucentis), bevacizumab (Avastin) and aflibercept (Eylea). We also discuss the ocular and systemic side effects of intravitreal anti-VEGF therapy as well as the future direction of anti VEGF therapy. Expert commentary: We describe some of the unknowns regarding anti-VEGF therapy including the lack of data on long term outcomes, the cost/benefit analysis over pan retinal laser treatment, and the heavy demand on patients for consistent follow up.