Therapeutic strategies targeting ocular vasculopathies: Current advances and emerging challenges

Ocular vasculopathies, including neovascular age-related macular degeneration (wet AMD), diabetic retinopathy, retinal vein occlusion, and radiation maculopathy, are major causes of vision loss driven by vascular endothelial growth factor (VEGF)-mediated neovascularization. Anti-VEGF therapies have transformed outcomes but face limitations from resistance, variable response, frequent injections, and adverse effects of broad VEGF blockade. This review discusses emerging approaches, including platelet-derived growth factor (PDGF), angiopoietin-2 (Ang-2), tyrosine kinase with immunoglobulin-like and EGF-like domains 2 (Tie2), and integrin inhibitors, alongside innovations in long-acting biologics, gene therapy, and nanocarriers. Complementary strategies targeting alternative angiogenic pathways, inflammation, hypoxia, and neuroprotection might overcome resistance and preserve retinal function. Together, these advances highlight opportunities to optimize therapy and address unmet needs in ocular vasculopathies.