ranibizumab + aflibercept + pegaptanib + verteporphin

This is a combination of four agents used in the management of neovascular (wet) age-related macular degeneration (AMD) and other retinal vascular diseases. The components are: - **Ranibizumab**: A monoclonal antibody fragment that binds to and inhibits all isoforms of vascular endothelial growth factor A (VEGF-A), thereby reducing abnormal blood vessel growth and leakage in the retina. - **Aflibercept**: A recombinant fusion protein acting as a decoy receptor for VEGF-A, VEGF-B, and placental growth factor, preventing their interaction with native receptors on endothelial cells. - **Pegaptanib**: An RNA aptamer that selectively binds to the VEGF165 isoform, inhibiting its activity and thus reducing pathological angiogenesis. - **Verteporfin**: A photosensitizer used in photodynamic therapy; after activation by light, it produces reactive oxygen species that damage abnormal blood vessels. These drugs act through complementary mechanisms targeting both angiogenic signaling pathways (anti-VEGF agents) and direct ablation of neovascular tissue (verteporfin). Combination regimens have been studied for potential additive or synergistic effects in controlling choroidal neovascularization[1][2][3][5][6].