Intravitreal treatments for exudative maculopathies: the efficacy/durability dilemma

Exudative retinal diseases represent a heterogeneous group of retinal disorders, characterized by different progression and outcome. The current therapeutic management has anti-VEGF molecules and corticosteroids as milestones. The two main factors to be considered are the efficacy of the treatments and the durability. The efficacy is mainly ruled by the capability of the drugs to target the pathogenic mediators, whereas the durability strictly depends on the half-life of each molecule. Increasing the efficacy of the treatments would mean to improve the management of the disease and the long-term outcome. Increasing the durability would mean to make even more feasible the long-term adherence to the treatments. Looking at the old and new generation molecules, it is possible to observe that the greater efforts of the companies have been mainly focused on increasing the durability of the treatments. However, the maintenance of the same therapeutic targets, with respect to the old generation drugs, raises some doubts regarding the tangible improvement of the long-term outcome of exudative retinal diseases. Hence, the main goal of the present review was to provide an updated overview of the current therapeutic targets and treatments, highlighting the need to address more in deep the efficacy/durability dilemma of the treatment of exudative retinal diseases, in order to maintain high patients' adherence to treatments and to improve the long-term visual outcome.