Pharmacovigilance in intraocular antiangiogenic therapy

Anti-VEGF (Vascular endothelial growth factor) agents have revolutionized ophthalmotherapy and are vital for various retinal disease treatment in ophthalmic practice. Ophthalmology has witnessed an explosion in the number of intravitreal injections delivered to patients over the past years. The rising popularity of anti-VEGF drugs came along with concerns about its safety in clinical use. The aim of this focused review is to critically analyze currently available findings on systemic safety. A literature search was conducted using PubMed, Web of Science, and Google Scholar databases for studies published from January 2012 to February 2025. The reference lists of meta-analyses and selected studies were also reviewed. Eighty four articles of high or medium clinical relevance were selected for review. The exclusion criteria included non-English language publications, articles directly unrelated to the review topic, commentaries, conference abstracts. Systemic safety concern in intraocular pharmacotherapy by antiangiogenic agents has a strong body of clinical evidence, resulting in plenty of peer reviewed clinical articles. It is certainly becoming recognized that anti-VEGF agents, despite given intraocularly, have the potential to cause systemic adverse events, such as cardiovascular, renal, neurological. Accumulating evidence obviate the need to raise medical professionals' awareness about systemic risk profile in patients with eye diseases treated by anti-VEGF, paying a special attention on patients with diabetes and older patients with multimorbidity. Early identification and prompt management of patients with undesirable systemic side effects secondary to intraocular pharmacotherapy by angiogenics can lessen disease severity, and help achieve earlier resolution.