April 2010
Volume 51, Issue 13
ARVO Annual Meeting Abstract  |   April 2010
Macular Epiretinal Brachytherapy in Treated Age-Related Macular Degeneration (MERITAGE): Interim Results
Author Affiliations & Notes
  • T. L. Jackson
    Ophthalmology, King's College Hospital, London, United Kingdom
  • P. U. Dugel
    Retinal Consultants of AZ Ltd, Phoenix, Arizona
  • R. Petrarca
    Ophthalmology, King's College Hospital, London, United Kingdom
  • J. Nau
    NeoVista, Freemont, California
  • Footnotes
    Commercial Relationships  T.L. Jackson, Research Grant, F; Travel reimbursement, R; P.U. Dugel, Research funding, F; Travel reimbursement, R; R. Petrarca, Travel reimbursement, R; J. Nau, Employee NeoVista, E.
  • Footnotes
    Support  Research Grant: NeoVista
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 1254. doi:
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      T. L. Jackson, P. U. Dugel, R. Petrarca, J. Nau; Macular Epiretinal Brachytherapy in Treated Age-Related Macular Degeneration (MERITAGE): Interim Results. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1254.

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

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Purpose: : To assess the safety and efficacy of epimacular brachytherapy for previously treated neovascular age-related macular degeneration (nAMD)

Methods: : 50 subjects with classic, minimally classic and occult lesions were enrolled. Entry criteria included a minimum of 3 intravitreal anti-VEGF retreatment injections in the 6 months preceding enrolment, or 5 injections in 12 months preceding enrolment. Subjects had received a mean of 12 injections prior to enrolment. Subjects underwent pars plana vitrectomy and 24 Gray beta irradiation for 4-5 minutes, using a retractable Strontium-90 source in an endoscopic probe (NeoVista, Freemont, CA). Anti-VEGF injections were administered if there was a 5 ETDRS letter loss, >50 micron central retinal thickness increase on optical coherence tomography (OCT), new macular hemorrhage, or new activity visible with fundus fluorescein angiography (FFA). Subjects were retreated with the same anti-VEGF agent they were receiving prior to enrolment (bevacizumab 1.25 mg or ranibizumab 0.5 mg). Monthly OCTs and regular FFAs (0, 1, 6, 12 months) were read centrally. Co-primary outcome measures were mean ETDRS visual acuity and mean number of anti-VEGF retreatment injections.

Results: : To date, 16 subjects have reached the 6 month milestone. Subjects received a mean of 2 retreatment injections with 88% maintaining vision and 63% gaining vision. Mean visual gain was 1.2 letters (+3.0 in pseudophakes). There was a favourable safety profile with no retinal breaks, detachments or radiation retinopathy.

Conclusions: : These interim results suggest that epimacular brachytherapy may reduce the need for anti-VEGF retreatment, whilst maintaining vision, however further follow-up is needed. Epimacular brachytherapy has the potential to reduce the treatment burden that patients face, and the financial cost to healthcare providers. A large (n 363) multicentre RCT (MERLOT) is now underway.

Clinical Trial: : www.clinicaltrials.gov NCT00809419

Keywords: age-related macular degeneration • radiation therapy • vitreoretinal surgery 

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