David P. Bingaman

Ocular angiostatic agents

As angiogenesis is important to the developing eye, continued proliferation in the post-natal period will result in a host of ocular disorders, many of which will lead to blindness. Significant inroads to the impedance of aberrant vessel growth have been derived from numerous fields of study including oncology, wound healing and ophthalmology. Angiogenesis is a complex process involving a variety of steps including: elaboration of angiogenic factors, activation of receptor linked signalling pathways, altered gene expression resulting in modulation of the receptor/signalling pathway or to the production of extracellular proteinases that degrade the vascular endothelial cell (VEC) basement membrane and components of the extracellular matrix. Extracellular modifications are required for migration of activated VECs and subsequent differentiation into newly formed blood vessels. To all aspects of the angiogenic cascade, new drug candidates have been described and tested in a variety of ocular neovascularisation models. A number of these agents are currently in clinical phases of investigation for disorders in both the anterior and posterior segments of the eye.

Novel Therapeutic Strategies For Posterior Segment Neovascularization

It is a time of increasing hope for those afflicted with devastating retinal diseases. Less than a decade ago, very few options were available for someone newly diagnosed with exudative AMD, and none of the possible treatments involved pharmacological intervention. Today, numerous pharmacological therapies are available, both approved and off-label, along with a variety of other treatment modalities. This chapter reviews the history and outcomes of different treatment methods of posterior segment neovascularization, from the early days of pharmacological intervention to ongoing clinical trials. It then summarizes the various directions that future research may take in pursuing the treatment of pathological ocular angiogenesis.