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P.T. Finger, Y.P. Gelman, A.M. Berson, A. Szechter; Palladium-103 Plaque Radiation Therapy for Exudative Age-Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1738.
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Purpose: To report the long-term results of palladium-103 ophthalmic plaque radiation therapy for exudative macular degeneration. Methods: Thirty-one eyes of 30 patients were treated for classic, occult, or recurrent subfoveal exudative macular degeneration. Standardized [ETDRS] visual acuity measurements were performed prior to treatment and then at 3 months intervals. Additional follow up information was obtained from referring physicians. Response to treatment was also evaluated by ophthalmoscopy and fluorescein angiography. During treatment of each patient, a gold ophthalmic plaque containing multiple radioactive palladium-103 seeds was surgically implanted beneath their involved macula. This involved temporary disinsertion of the lateral rectus muscle. Radiation was delivered to a mean 17.6 Gy dose over a mean 34 hours during one brachytherapy session. After treatment the plaque was removed. Results: Patients have been followed for up to 7-years. At a mean 33.3 months, forty-five percent of patients were within or improved more than 2 lines of their initial visual acuity. The most common finding in patients followed for greater than 6 months was regression to stabilization of the exudative process [n=18 of 29 (62%)]. No radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, or dry eye could be attributed to radiation therapy. In addition, there were no complications related to surgery. Conclusions: In comparison to external beam therapy, implant brachytherapy allows more radiation to be delivered to the macula with less to most normal ocular structures. In this series and at the doses prescribed, plaque radiation therapy was well tolerated. Though our visual acuity results are encouraging, we believe a prospective randomized masked clinical trial should be performed to evaluate the efficacy of this treatment.
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