Article
Epimacular brachytherapy – a new treatment option for neovascular ARMD
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Published: | June 15, 2011 |
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Background: The observation that long term follow-up of neovascular ARMD treated with anti-VEGF shows a decrease of visual acuity and the fact that certain subtypes of wet ARMD cannot be sufficiently treated with anti-VEGF demonstrates the need of alternative treatment options. Ionizing radiation seems to be a logical treatment. Cells in segmentation can be affected by radiation, scar reaction is reduced and local inflammation can be minimized.
Methods: In a randomized multicenter study (MERITAGE) a total of 53 patients that received – after initial treatment with a loading dose of 3 anti-VEGF injections – a minimum of 6 additional injections in the 12 months preceding enrollment or 3 injections in the last 6 months were enrolled. The patients were treated with vitrectomy, epimacular brachytherapy and an additional ranibizumab injection. Besides the data of this study, first impressions of the use of epimacular in clinical routine in Hamburg will be presented.
Results: A total of 53 patients with wet ARMD were included. 49 patients could be included in the 18 months follow up. In this collective the average amount of injections prior to brachytherapy was 12.2. 18 months after radiation the average was 5.6 injections. 18% of patients had received no additional anti-VEGF injection. 39% received less than 2 injections during this 18 months period. Visual acuity could be stabilized or improved in 84% of patients with an average improvement of 6.6 letters.
Conclusion: The current monotherapy model with anti-VEGF is a great burden for all involved persons. With epimacular brachytherapy we have a new and promising treatment option for refractory wet ARMD.