Name: Duravyu (vorolanib intravitreal insert) in Wet age-related macular degeneration: Pathophysiology
Published: 2026-09-17T18:16:06-04:00

Product information and disease description Place of product in therapy Disease description

Pathophysiology

4 evidence topics · 3 sources

Macular neovascularization subtypes: consensus nomenclature

“Type 3 neovascularization is to be used when the vascular complex originates in the retina. Type 1 neovascularization is applied when the vessels originate from the choroid and remain under the RPE. Type 2 neovascularization is denoted if neovascularization that originates in the choroid breaks through the RPE to reach the subretinal space.” (opens the source at this quote in a new tab)

Macular neovascularization subtypes and their consequences: guideline

“Type 1 MNV: a neovascular complex located in the sub-RPE space originating from the choroid through a defect in Bruch’s membrane” (opens the source at this quote in a new tab)
“Type 2 MNV: a neovascular complex located in the subretinal space above the RPE originating from the choroid” (opens the source at this quote in a new tab)
“Type 3 MNV: pathologic angiogenesis originating from the deep retinal capillary plexus and extending to the outer retina (historically referred to as retinal angiomatous proliferation)” (opens the source at this quote in a new tab)
“Macular neovascularization can lead to the following:” (opens the source at this quote in a new tab)
“Subretinal fibrosis (formerly known as disciform scar)” (opens the source at this quote in a new tab)

VEGF as a mediator of angiogenesis and vascular permeability

“VEGF (Vascular endothelial growth factor): A significant mediator in the process of angiogenesis and increased vascular permeability and inflammation. It has been identified in neovascularization related to both diabetic retinopathy and AMD. In animal models, the introduction of VEGF has initiated the cascade of neovascularization seen in AMD.” (opens the source at this quote in a new tab)

Proposed signaling pathway from lipoprotein debris to VEGF-driven MNV

“7-Ketocholesterol is thought to activate microglia to release cytokines, such as TNF, which mediates VEGF expression in RPE cells and its release preferentially from the basal aspects147. It has been further proposed that the secreted VEGF promotes choroidal endothelial cell activation and migration, potentially by interactions with integrins in ECM components148 and by activating GTPases, namely Rac1 (REF.145).” (opens the source at this quote in a new tab)
“Furthermore, the generated ROS presumably also diminish the RPE barrier integrity and permit secreted VEGF entry into the retina, which promotes choroidal endothelial cell migration, proliferation and eventually MNV formation149.” (opens the source at this quote in a new tab)
“The conversion of non-exudative MNV to exudative MNV is likely to be a major disease transition point in neovascular AMD.” (opens the source at this quote in a new tab)