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# Intravitreal anti-VEGF agents

Proteins injected into the eye that block VEGF, the signal behind the leaky new vessels of wet macular degeneration and diabetic eye disease.

Updated Nov 1, 2026

## What they are

Biological medicines given by intravitreal injection. They treat diseases in which the retina makes too much vascular endothelial growth factor A (VEGF-A): wet age-related macular degeneration, diabetic macular oedema and retinopathy, and macular oedema after retinal vein occlusion.

## Mechanism of action

VEGF-A makes endothelial cells divide and makes vessels leaky. Anti-VEGF agents bind VEGF-A before it reaches its receptors: ranibizumab is an antibody fragment, aflibercept a soluble decoy receptor built from parts of VEGF receptors 1 and 2. Less VEGF signalling means less new-vessel growth, less leakage and less macular oedema.

Target: Vascular endothelial growth factor A (VEGF-A) in the retina

## Key points

- Given only by intravitreal injection, by an eye specialist, with aseptic technique.
- Injection risks: endophthalmitis and a rise in intraocular pressure; both are checked after each injection.
- Active infection or active inflammation in or around the eye is a contraindication.
- Rare arterial events such as stroke have been linked to anti-VEGF agents.
- Ranibizumab is an affinity-matured Fab derived from bevacizumab; aflibercept is a VEGF decoy receptor.

## Drugs in this class

- [**Aflibercept** A decoy receptor injected into the eye. It soaks up VEGF so fewer leaky vessels grow in wet macular degeneration and… VEGF-A (and placental growth factor), bound as a soluble decoy](https://durgical.com/en/pharmacology/aflibercept/)
- [**Ranibizumab** An antibody fragment injected into the eye that binds VEGF-A and slows the leaky vessels of wet macular degeneration… VEGF-A (vascular endothelial growth factor A)](https://durgical.com/en/pharmacology/ranibizumab/)

## Others in the class

- Bevacizumab (used off-label in the eye)
- Brolucizumab
- Faricimab (also blocks angiopoietin-2)

## Test yourself

Think of the answer, then tap the question to see it.

## Which growth factor do intravitreal anti-VEGF agents block?

Vascular endothelial growth factor A (VEGF-A).

## What are the two main risks of the injection itself?

Endophthalmitis and a rise in intraocular pressure.

## How does aflibercept differ structurally from ranibizumab?

Aflibercept is a fusion protein made of VEGF receptor parts (a decoy receptor); ranibizumab is an antibody fragment.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Aflibercept Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a612004.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Ranibizumab Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a607044.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=S01LA) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/intravitreal-anti-vegf-agents/