Retinal vein occlusion: drug targets and therapeutic implications

ABSTRACT

Introduction

The pathogenesis of retinal vein occlusion (RVO) is extremely complex and includes several mediators. These mediators represent potential drug targets that can be used in the development of intravitreal drugs.

Areas covered

PubMed/MEDLINE databases were accessed between April-May 2021 to find the most relevant scientific papers regarding drug targets and therapeutic implications in RVO, focusing on current therapeutic options and potential cornerstones of future advances in treatment.

Expert opinion

Before the introduction of intravitreal therapies, the visual outcome following a diagnosis of RVO was extremely poor. Anti-VEGF and corticosteroid treatments have radically changed RVO prognosis, helping to preserve patients’ visual function and their quality of life. According to current clinical data, anti-VEGF and corticosteroid drugs are associated with both pros and cons; the present recommendation is to employ anti-VEGF molecules as a first-line treatment. Advances in our understanding of the biomolecular characteristics of RVO offer a solid basis for the development of new therapeutic targets and treatments.

KEYWORDS:

• Retinal vein occlusion
• CRVO
• BRVO
• anti-VEGF
• corticosteroids
• intravitreal injections
• laser

Article highlights

• Retinal vein occlusion (RVO) is a leading cause of visual acuity loss in developed countries.

• The mediators involved in RVO pathogenesis include VEGF, angiopoietin-1, angiopoietin-2, pro-inflammatory cytokines, interleukins, chemokines, intercellular adhesion molecules, PIGF, PDGF, fibronectin, complement factors, fibrinogen chains, apolipoprotein C-III, sirtuin-1 and pentraxin 3.

• The current management of RVO is based on intravitreal anti-VEGF injections and corticosteroid implants.

• Targeting VEGF and employing intravitreal corticosteroids are powerful ways to address the cascades of pro-inflammatory and angiogenic mediators characterizing RVO.

• Future research is focused on the development of new therapeutic targets, to enlarge the spectrum of mediators blocked by treatments, and to improve the duration of the therapeutic effects, considering the recurrent behavior of RVO-related manifestations.

Declaration of interests

F Bandello is consultant for: Alcon (Fort Worth, Texas, USA), Alimera Sciences (Alpharetta, Georgia, USA), Allergan Inc (Irvine, California, USA), Farmila-Thea (Clermont-Ferrand, France), Bayer Shering-Pharma (Berlin, Germany), Bausch And Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), NovagaliPharma (Évry, France), Novartis (Basel, Switzerland), Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee, Belgium), Zeiss (Dublin, USA). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded