Table 9.

Clinical guidelines for anti-VEGF use across different systems

System	Guidelines
Renal	Exercise caution in patients with significantly compromised renal function (eGFR < 30 mL/min/1.73m2)
	Close monitoring is advised to detect potential renal impact
Cardiovascular (CVS)	Prior stroke or MI within 6–12 months is a stronger predictor of cardiovascular risk than prolonged q4 injections
	Long-term frequent injections (> 10 years) may contribute to gradual cardiac dysfunction
	—
Central nervous system (CNS)	Most of the literature does not report significant long-term systemic side effects or neurological impairment associated with anti-VEGF use
	Caution is advised when administering anti-VEGFs to patients with a recent history of stroke, as repeated injections may elevate stroke risk
Pregnancy	Anti-VEGFs should be used only when the potential benefit to the woman justifies the potential fetal risks
	A routine urinary pregnancy test can be considered before treatment in women of childbearing age
	Ranibizumab appears safer than other anti-VEGFs in pregnancy
	Avoid intravitreal anti-VEGF treatment during the first trimester, particularly in high-risk cases
Breastfeeding	Ranibizumab appears to be a safer option than aflibercept for breastfeeding women
	A 3-day “pump and dump” strategy is recommended after intravitreal injections
Retinopathy of prematurity (ROP)	Anti-VEGF therapy can be considered for vision-threatening ROP cases after carefully weighing risks and benefits

VEGF vascular endothelial growth factor, eGFR estimated glomerular filtration rate, MI myocardial infarction