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Adiel Barak, Dinah Zur, Anat Loewenstein; Epimacular Brachytherapy In The Treatment Of Neovascular Age-Related Macular Degeneration - Short-Term Results From Clinical Practice. Invest. Ophthalmol. Vis. Sci. 2012;53(14):842.
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The Meritage trial showed that epiretinal strontium-90 brachytherapy in subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) reduces the number of PRN Bevacizumab injections. Patients unresponsive to repeated anti-VEGF injections were offered this treatment. We report clinical experience and short-term follow-up results.
In this prospective, non-randomized single-center case-series all patients who underwent epimacular strontium-90 brachytherapy during a period of 5 months are presented. 23G pars plana vitrectomy was performed under local anesthesia. 24G brachytherapy using NeoVista device (intraocular strontium-90 applicator; NeoVista, Fremont, California) was applied for four minutes. Afterwards, 1.25 mg Bevacizumab or 0.5 mg Ranibizumab was injected intravitreal. The procedure was performed by two vitreoretinal surgeons. Follow-up visits were at postoperative day 7 and monthly afterwards. Patients were eligible to receive further anti-VEGF injections on PRN basis.
15 patients were treated; 14 had prior anti-VEGF treatments. One patient with naive CNV was unable to receive monthly injections. Six patients were pseudophakic. The surgical procedure was performed without complications or technical difficulties in all cases. No device-related adverse events were observed. During 4 months follow-up, there was no case of severe visual loss. Three patients improved by ≥1 line on Snellen chart. Detailed clinical results including visual outcome and anatomic results on optical coherence tomography are presented.
Epimacular brachytherapy is feasible in clinical practice and should be considered in patients unresponsive to anti-VEGF treatments. Longer follow-up is needed to evaluate efficacy and recognition of patients which can take advantage of combined radiation and anti-VEGF therapy.
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