Suprachoroidal drug delivery for VEGF suppression in wet AMD and other diseases with choroidal neovascularization.

Abstract

PURPOSE Choroidal neovascularization caused by age-related macular degeneration, among other diseases, causes significant visual impairment. Intravitreal therapeutics inhibiting vascular endothelial growth factor (VEGF) signaling have shown excellent safety and efficacy in regressing choroidal neovascularization and improving vision. Current FDA-approved treatments deliver these drugs into the vitreous cavity, even though choroidal neovascularization originates from aberrant signaling in the choroid. DESIGN Systematic review METHODS: A literature search was conducted across PubMed and Google Scholar from inception up to December 31, 2024, focusing on studies investigating suprachoroidal delivery of anti-VEGF therapy. Randomized controlled trials, cohort studies, and case-control studies were included, while case reports and review articles were excluded. RESULTS Fifteen peer-reviewed articles, 3 press releases, 6 conference abstracts and presentations, and 8 clinical trials were identified that relevant to the topic of suprachoroidal delivery of anti-VEGF therapy. CONCLUSION The suprachoroidal space is a potential space between the sclera and the choroid, which has recently become a route of delivery in an FDA-approved treatment. Notably, suprachoroidal delivery results in higher choroidal drug concentrations than intravitreal delivery. Promising results thus far have been seen with suprachoroidal delivery of VEGF-targeting therapies in clinical and pre-clinical studies; future work is needed to more-fully demonstrate safety and efficacy.