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The human retina may be affected by two macro groups of diseases, namely maculopathies and retinopathies. Whereas maculopathies are confined to the central part of the retina, bounded by the vascular arcades, retinopathies may extend up to the extreme retinal periphery. These two categories can be further subdivided according to the main features characterizing the disease, thus taking into consideration exudative or atrophic phenomena.
The management of exudative retinal diseases underwent a revolution due to the introduction of intravitreal treatments. There are two main classes of intravitreal drugs, namely anti-vascular endothelial growth factors (anti-VEGF) and corticosteroids molecules. The clinical course and the outcome of retinal diseases radically changed thanks to the efficacy of these molecules in determining the regression of the exudation and the restoration of the macular profile.
Exudation is an active process, and its nature depends on each specific retinal disease, causing fluid to accumulate within the retina or in the subretinal space. It mainly involves variable amounts of fluid, the major pathogenic features of which are the breakdown of the blood-retinal barrier and increased inflammation . Retinal diseases can also be characterized by other types of debris, including lipofuscin and lipidic and proteinaceous materials . Retinal diseases can also be characterized by the progressive degeneration of inner and outer retinal layers. These atrophic changes may occur independently or in the context of an initial exudative disease .
Current retinal therapeutic approaches are based on these premises and designed to prompt the exudation to regress, stimulate debris reabsorption or prevent the atrophy from expanding.
2. Retinal Drugs for Exudative Diseases
The prognosis of retinal exudative diseases changed radically after the introduction of intravitreal therapies. While the old laser-based treatments were effective in blocking exudation, they were associated with an extremely poor visual outcome ; nowadays, patients can expect to preserve their quality of life and a good visual function. The current intravitreal therapeutic bullets consist of anti-vascular endothelial growth factor (anti-VEGF) and corticosteroids. The pros of anti-VEGF drugs are their easier management and the low instance of side effects; the cons comprise their limited duration, meaning a large number of injections are required, and their contraindication in patients displaying a high risk of cardiovascular dysfunction. In contrast, the pros of corticosteroids include their longer duration, thus reducing the number of injections administered and their greater anti-inflammatory action. Conversely, corticosteroids are closely associated with an increase in intraocular pressure and a faster progression of cataracts.
3. The Role of Inflammation in the Human Retina
4. Emerging Therapies for Exudative Retinal Diseases
4.3. Complement Inhibitors
4.4. Integrins Inhibitors
5. Retinal Drugs for Non-Exudative Diseases
5.1. Complement Inhibitors
The entry is from 10.3390/pharmaceutics13071102
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