September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016

Low energy stereotactic radiotherapy in combination with an anti VEGF treat and extend regimen for treatment of neovascular age related macular degeneration: 12 month outcomes
Author Affiliations & Notes
  • Katja B Hatz
    Vista Klinik, Binningen, Switzerland
    Dep. of Ophthalmology, Kantonsspital Baselland, Liestal, Switzerland
  • Frank Zimmermann
    Dep. of Radiooncology, University Hospital Basel, Basel, Switzerland
  • Dimitrios Kardamakis
    Dep. of Radiooncology, Medical School Patras, Patras, Greece
  • Emmanouil Lazaridis
    EyeRAD SWISS Medical Center, Basel, Switzerland
  • Cengiz Tuerksever
    Vista Klinik, Binningen, Switzerland
    Dep. of Ophthalmology, Kantonsspital Baselland, Liestal, Switzerland
  • Christian Pruente
    Vista Klinik, Binningen, Switzerland
    Dep. of Ophthalmology, Kantonsspital Baselland, Liestal, Switzerland
  • Footnotes
    Commercial Relationships   Katja Hatz, Allergan Switzerland (F), Bayer Switzerland (F), Novartis Switzerland (F); Frank Zimmermann, None; Dimitrios Kardamakis, None; Emmanouil Lazaridis, Oraya Inc. (I); Cengiz Tuerksever, None; Christian Pruente, Allergan Switzerland (F), Bayer Switzerland (F), Novartis Switzerland (F)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3692. doi:
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      Katja B Hatz, Frank Zimmermann, Dimitrios Kardamakis, Emmanouil Lazaridis, Cengiz Tuerksever, Christian Pruente;
      Low energy stereotactic radiotherapy in combination with an anti VEGF treat and extend regimen for treatment of neovascular age related macular degeneration: 12 month outcomes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3692.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To investigate the 12 month outcomes of low energy stereotactic radiotherapy (SRT) in combination with intravitreal anti VEGF treatment in a treat and extend (TER) regimen in neovascular AMD.

Methods : Retrospective case series of eyes which completed at least a 12 months follow up after receiving a single session low energy SRT treatment (16 Gy) due to persistent choroidal neovascularization (CNV) activity despite 4 weekly anti VEGF injections or necessity for frequent injection treatments (4 or 6 weekly) in wet AMD. The previous to SRT used TER was continued in the same manner and with the same anti VEGF drug during follow up. Evaluations included best corrected visual acuity (BCVA), central retinal thickness (CRT) at spectral domain optical coherence tomography (SD-OCT), qualitative SD-OCT evaluations and recurrence free treatment interval at baseline, 3, 6, 9 and 12 months after SRT.

Results : From 50 eyes from 50 patients, 30 eyes (60%) had been treated before baseline in an aflibercept TER, 20 (40%) in a ranibizumab TER. After SRT, a significant reduction in CRT was seen from baseline to 12 months (407.3±153.2 µm to 320.2±112.1 µm; p<0.001), which showed to be significant from month 2 onwards (384.2±153.2 µm; p=0.009). BCVA was stable over 12 months with no significant change (baseline 64.0±15.1 letters, 12 months 63.6±16.2 letters). There was a significant increase in the mean maximum recurrence-free interval: from 4.24±0.66 weeks at baseline to 4.76±1.25 weeks at 3 months, 5.66±2.08 at 6 months, 6.62±2.78 at 9 months and 7.52±3.05 at 12 months (p<0.001 for all compared to baseline). Being continuously treated with TER, at baseline we found in SD-OCT 14% (7) of lesions without intra-or subretinal fluid, 50% (25) with only subretinal fluid, 16% (8) with only intraretinal fluid and 20% (10) with both, sub- and intraretinal fluid, while at 12 months a reduction in these morphological activity CNV signs in SD-OCT was seen (66% (33) without fluid, 20% (10) with only subretinal fluid, 12% (6) with only intraretinal fluid, 2% (1) with sub- and intraretinal fluid). No severe side effects were observed.

Conclusions : Low energy SRT, applied in combination with an anti VEGF TER schedule, presents a good option for a combination treatment with anti VEGF therapy to reduce CNV activity and the anti VEGF injection frequency.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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