Intravitreal Anti–VEGF Therapies in the Management of Retinal Vascular Diseases: A Review of Molecular Mechanisms, Clinical Applications, Dosing Strategies, Emerging Agents, and Future Directions

Vascular endothelial growth factor (VEGF) is a key regulator of ocular angiogenesis and vascular permeability, contributing to major retinal vascular disorders, including neovascular age-related macular degeneration, diabetic macular oedema, proliferative diabetic retinopathy, and retinal vein occlusion–associated macular oedema. Intravitreal anti-VEGF therapy has revolutionised management of these conditions, resulting in significant improvements in both visual acuity and retinal anatomy. Established intravitreal agents include bevacizumab, ranibizumab, aflibercept, faricimab, and, in selected circumstances, brolucizumab. More recent approaches, including high dose aflibercept, implant based ranibizumab delivery, biosimilars, and investigational sustained-delivery systems aim to improve treatment durability while preserving efficacy and safety. This review summarises molecular mechanisms of VEGF inhibition, clinical indications, dosing strategies, safety considerations, and long-term outcomes. Emerging therapies, sustained-release delivery systems, biosimilars, and future directions in anti-VEGF therapy are also discussed, highlighting ongoing efforts to optimize efficacy, safety, and patient adherence in the evolving landscape of retinal disease management.