THREE-YEAR SAFETY and VISUAL ACUITY RESULTS of EPIMACULAR (90)STRONTIUM/(90)YTTRIUM BRACHYTHERAPY WITH BEVACIZUMAB for the TREATMENT of SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION

THREE-YEAR SAFETY and VISUAL ACUITY RESULTS of EPIMACULAR (90)STRONTIUM/(90)YTTRIUM BRACHYTHERAPY WITH BEVACIZUMAB for the TREATMENT of SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION

Author Avila, Marcos P. Google Scholar
Farah, Michael E. Autor UNIFESP Google Scholar
Santos, Arturo Google Scholar
Carla, Livia Google Scholar
Fuji, Gildo Autor UNIFESP Google Scholar
Rossi, Juliana Autor UNIFESP Google Scholar
Nau, Jeffrey Google Scholar
Institution Fed Univ Goiana
Universidade Federal de São Paulo (UNIFESP)
Med Ctr Puerta de Hierro
NeoVista Inc
Abstract Purpose: To evaluate the long-term safety and visual acuity outcomes associated with epimacular strontium 90 brachytherapy combined with intravitreal bevacizumab for the treatment of subfoveal choroidal neovascularization because of age-related macular degeneration.Methods: Thirty-four treatment-naive patients with predominantly classic, minimally classic, and occult subfoveal choroidal neovascularization lesions participated in this prospective, 2-year, nonrandomized multicenter study. Subjects from 1 center (n = 19) were reconsented and followed-up for 3 years. Each subject received a single 24-Gy beta irradiation treatment via an intraocular delivery device and 2 planned injections of bevacizumab at treatment and 1 month later. Additional bevacizumab therapy was permitted based on prespecified retreatment criteria. Adverse events were observed, and best-corrected visual acuity was measured using Early Treatment Diabetic Retinopathy Study vision charts. Subjects were evaluated every 3 months during the first year of follow-up and every 6 months during Years 2 and 3 of follow-up.Results: All 34 subjects were followed-up for 24 months and 19 were followed-up through 36 months. With up to 24 months of follow-up, 12 of 24 phakic patients (50%) exhibited >= 2 grades of progression in Lens Opacification Classification System (LOCS) II lens classification; 5 eyes underwent cataract extraction before the Month 36 visit. There was 1 case of nonproliferative retinopathy identified at 36 months of follow-up that did not have an adverse effect on visual acuity, was stable at 43 months of follow-up, and was isolated to the parafoveal region. Mean best-corrected visual acuity demonstrated an average gain of +15.0 and -4.9 letters at 12 months and 24 months, respectively; the drop in mean gain at Month 24 was largely attributable to cataract formation. At 36 months (n = 19), the mean best-corrected visual acuity was +3.9, 90% (17 of 19) of eyes had lost <15 letters from baseline, 53% (10 of 19) had gained >= 1 letter, and 21% (4 of 19) had gained >= 15 letters. Through 36 months, 11 eyes required additional bevacizumab retreatment therapy and received a mean of 3.0 injections (range, 2-7 injections).Conclusion: Epimacular brachytherapy shows promise as a therapeutic option for subfoveal neovascular age-related macular degeneration. the procedure was safe and well tolerated, with a reasonable risk-benefit profile that warrants further study in larger subject populations. the most common adverse event was cataract progression/formation. Surgical complications are similar to those expected from standard vitrectomy trials. This novel device is currently being evaluated in two prospective, randomized, controlled trials in treatment-naive subjects (CABERNET) and in subjects already treated with anti-vascular endothelial growth factor therapy (MERLOT). RETINA 32:10-18, 2012
Keywords age-related macular degeneration
subfoveal choroidal neovascularization
epiretinal brachytherapy
bevacizumab
radiation
anti-VEGF therapy
combination therapy
Language English
Date 2012-01-01
Published in Retina-the Journal of Retinal and Vitreous Diseases. Philadelphia: Lippincott Williams & Wilkins, v. 32, n. 1, p. 10-18, 2012.
ISSN 0275-004X (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 10-18
Origin http://dx.doi.org/10.1097/IAE.0b013e31822528fc
Access rights Closed access
Type Article
Web of Science ID WOS:000298661800003
URI http://repositorio.unifesp.br/handle/11600/34482

Show full item record




File

File Size Format View

There are no files associated with this item.

This item appears in the following Collection(s)

Search


Browse

Statistics

My Account