The role of VEGF-directed drugs in the treatment of diabetic retinopathy and macular edema: What an endocrinologist needs to know

Diabetic retinopathy (DR) and diabetic macular edema (DME) are the most common microangiopathic complications of diabetes mellitus, that represent one of the most relevant problems of modern healthcare. DR is the fifth most common cause of blindness worldwide and the main cause of vision loss in patients with diabetes. Proliferative DR (PDR) is the last stage of this complex retinal disease and is characterized by abnormal production of vascular endothelial growth factor (VEGF), which is one of the most important pathogenic factors of DR. based on the current data on DR development and the role of VEGF, there can be identified several therapeutic strategies. Panretinal photocoagulation (PRP) is the standard treatment for proliferative diabetic retinopathy. In addition, combination of PRP and intravitreal administration of antiVEGF drugs is considered the most effective method for the management of DME. Modern strategies in diabetology and ophthalmology include anti-VEGF therapy that has radically changed the outcome of DR due to its antiangiogenic activity. Currently, the most effective anti-VEGF drugs are ranibizumab, brolucizumab and aflibercept. They have significantly changed the prognosis of patients, due to achieving better visual acuity and preventing the progression of DR and vision-threatening complications. In the present review, we have provided up-to-date information on the role of VEGF in the pathogenesis of DR, as well as on the current management strategies of DR and DMO.