Intravitreal Angiogenesis Inhibitors For Choroidal Vascular Conditions

Angiogenesis inhibitors (eg, ranibizumab, bevacizumab, pegaptanib, aflibercept) are being evaluated for the treatment of disorders of choroidal circulation. Ophthalmic disorders affecting the choroidal circulation include age-related macular degeneration (AMD), central serous chorioretinopathy (CSC), pathologic myopia, presumed ocular histoplasmosis syndrome, angioid streaks, idiopathic choroidal neovascularization (CNV), uveitis, choroidal rupture or trauma, and chorioretinal scars. The available literature from randomized controlled trials supports the use of antivascular endothelial growth factor (anti-VEGF) therapies (ranibizumab, bevacizumab, pegaptanib, aflibercept) as monotherapy for the treatment of CNV associated with AMD. The use of anti-VEGF therapies for CNV secondary to other relatively rare disorders of choroidal circulation (angioid streaks, CSC, choroidal rupture or trauma, idiopathic CNV, multifocal choroiditis, pathologic myopia, presumed ocular histoplasmosis syndrome, and uveitis) is supported by a few small randomized trials, numerous case series, and clinical input. Therefore, anti-VEGF therapies (ranibizumab, bevacizumab, pegaptanib aflibercept) may be considered medically necessary for CNV associated with these conditions. Anti-VEGF therapies are considered investigational for the treatment of chorioretinal scars.