Anti-vascular endothelial growth factor therapy in uveitis: Bridging inflammation and vascular pathology

Anti-vascular endothelial growth factor (VEGF) therapy has emerged as an important adjunct in the management of uveitis, particularly for complications driven by vascular permeability and ischemia, such as uveitic macular edema, inflammatory choroidal neovascularization, and retinal neovascularization (RNV). By directly neutralizing VEGF, these agents offer rapid anatomical improvement and visual stabilization, especially in patients who are steroid-intolerant or present with refractory disease. Although current evidence is largely derived from small series and observational data, the accumulating clinical experience highlights a meaningful therapeutic role for anti-VEGF agents when used in conjunction with appropriate immunosuppression or antimicrobial therapy. Emerging roles extend to inflammatory RNV, tubercular granulomas, and serous retinal detachment. However, sterile intraocular inflammation, vasculitis, and rare endophthalmitis remain important safety concerns. Evolving delivery strategies, including sustained-release formulations, posterior sub-Tenon and exploratory topical approaches, may further expand their utility while improving safety. This review synthesizes current evidence, mechanistic insights, and future directions for integrating anti-VEGF therapy in uveitis care.