Low-Energy Stereotactic Radiotherapy for Treatment of Exudative Age-Related Macular Degeneration in a Treat-and-Extend Regimen

Ophthalmic Surg Lasers Imaging Retina. 2018 Feb 1;49(2):86-93. doi: 10.3928/23258160-20180129-02.

Abstract

Background and objective: To evaluate the effectiveness and safety of low-energy stereotactic radiotherapy (SRT) combined with anti-vascular endothelial growth factor (VEGF) treatment following a treat-and-extend regimen (TER) in wet age-related macular degeneration (AMD).

Patients and methods: Before/after SRT, the authors compared retrospective consecutive case series of 50 patients requiring frequent anti-VEGF treatment (every 4 or 6 weeks) in wet AMD, treated with a single session of SRT and TER (same manner pre/post-SRT). Outcomes were visual acuity (VA), recurrence-free interval, and central retinal thickness (CRT).

Results: After SRT, CRT was reduced from baseline (407.3 μm ± 153.2 μm) to 12 months (320.2 μm ± 112.1 μm; P < .001), with statistical significance from month 2 onward. VA was stable for 12 months (64.0 letters ± 15.1 letters vs. 63.6 letters ± 16.2 letters). The mean recurrence-free interval increased from 4.24 weeks ± 0.66 weeks to 7.52 weeks ± 3.05 weeks at 12 months (P < .001). No severe side effects were observed.

Conclusion: Low-energy SRT, combined with anti-VEGF TER, was associated with reduced injection frequency and preserved VA during 12 months of follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:86-93.].

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use
  • Female
  • Humans
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Radiosurgery / methods*
  • Ranibizumab / therapeutic use
  • Receptors, Vascular Endothelial Growth Factor / therapeutic use
  • Recombinant Fusion Proteins / therapeutic use
  • Retina / pathology
  • Retrospective Studies
  • Visual Acuity / physiology
  • Wet Macular Degeneration / drug therapy
  • Wet Macular Degeneration / radiotherapy*

Substances

  • Angiogenesis Inhibitors
  • Recombinant Fusion Proteins
  • aflibercept
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab