Table 3 Anti-vascular endothelial growth factor (VEGF) agents and their safety profile in pregnancy.
From: Management of uveitic and chorioretinal conditions in pregnancy
Anti-VEGF agent | Indication for treatment | Target | Molecular weight | Dose per injection | Adverse effects | Safety profile in pregnancy—teratogenicity |
|---|---|---|---|---|---|---|
Ranibizumab (Lucentis® and biosimilars) | Macular neovascularisation due to myopia, uveitis/inflammation etc. | VEGFA | 48 kDa | 0.5 mg | Ocular: Subconjunctival haemorrhage, inflammation, bleeding, retinal tear/detachment, vitreous haemorrhage, cataract, increased intraocular pressure, endophthalmitis, corneal abrasion, occlusive retinal vasculitis (rare) | Preferred if anti-VEGF required. Lowest risk (lowest systemic absorption, shortest half-life), no reported toxicity (animals) |
Aflibercept (Eylea®) | VEGF A, VEGF B, PDGF | 97–115 kDa | 2 mg | Avoid due to theoretically higher risk of systemic absorption | ||
Faricimab (Vabysmo®) | Diabetic macular oedema | VEGF A, Ang-2 | 150 kDa | 6 mg | Avoid due to inadequate data | |
Bevacizumab (Avastin®) | Cystoid macular oedema due to retinal vein occlusion | VEGFA | 149 kDa | 1.25 mg | Systemic use associated with embryotoxicity Not licensed for intravitreal use (except in neovascular AMD)—available off-label | |
Brolucizumab (Beovu®) | VEGF A | 26 kDa | 6 mg | Avoid due to inadequate data |
