REVIEW Emerging therapeutic approaches in the management of retinal angiogenesis and edema An Truong & Tien Y. Wong & Levon M. Khachigian Received: 18 July 2010 / Revised: 22 October 2010 / Accepted: 10 November 2010 / Published online: 18 December 2010 # Springer-Verlag 2010 Abstract Conditions resulting in retinal angiogenesis and edema (exudative age-related macular degeneration, diabetic retinopathy, retinal vein occlusion and retinopathy of prematurity) are major causes of visual impairment, with significant impact on quality of life. There has been increasing clinical usage of anti-vascular endothelial growth factor (anti-VEGF) agents to stop retinal angiogenesis and resolve intraretinal fluid arising from these conditions. However, anti-VEGFs have not been completely successful in curing these conditions, and a range of emerging treatments aimed at supplementing or competing with anti-VEGF agents are being developed. We will discuss the proposed merits these emerging agents bring to the treatment arsenal and how they compare with anti-VEGFs with regards to therapeutic activity, potency, specificity and safety. This review will also highlight recent pre-clinical research findings and suggest where future research might be directed. Keywords Retinal angiogenesis . Retinal edema . Age-related macular degeneration (AMD) . Diabetic retinopathy (DR) . Neuronal degeneration . Anti-VEGF Introduction Retinal angiogenesis and edema feature in several common eye diseases of the posterior segment, such as diabetic retinopathy (DR), exudative or ‘wet’ age-related macular degeneration (AMD), retinal vein occlusions, Coat’ s disease, retinopathy of prematurity (ROP) and pathological myopia. In most countries, AMD and DR are the leading causes of blindness in those over 50 years of age and the working age populations, respectively [1–5]. The prevalence of these conditions is expected to soar in the next few decades due to estimated increases in the aged population, obesity and diabetes [6, 7]. These visually debilitating conditions can result in loss of independence of an individual and represent a significant cost to the community. It is therefore of great interest to patients and physicians that therapies to alleviate the morbidity of these conditions be developed. In the last decade, rapid therapeutic advances and improved under- standing of the abovementioned conditions have allowed the introduction and use of medical agents to suppress angio- genesis and edema. Here, we discuss how the field is set to change in the coming years through the development of promising clinical agents and approaches. Retinal angiogenesis and edema Angiogenesis is the generation and growth of new vessels from the existing vasculature. With the exception of collateral formation during ischemia, retinal angiogenesis detrimentally affects visual function. Angiogenic vessels A. Truong : L. M. Khachigian (*) Centre for Vascular Research, University of New South Wales, 3rd floor, Lowy Cancer Research Centre, Sydney, NSW 2052, Australia e-mail: L.Khachigian@unsw.edu.au T. Y. Wong Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, Melbourne, VIC 3002, Australia T. Y. Wong Singapore Eye Research Institute, National University of Singapore, 11 Third Hospital Avenue, Singapore, Singapore J Mol Med (2011) 89:343–361 DOI 10.1007/s00109-010-0709-z