Macular Epiretinal Brachytherapy in Treated AMD
Here, the optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) results of the Macular Epiretinal Brachytherapy in Treated Age-Related Macular Degeneration study are reported.
A total of 53 eyes of 53 participants with chronic, active neovascular age-related macular degeneration (AMD) requiring frequent anti-vascular endothelial growth factor (anti-VEGF) retreatment were included in this prospective, multicenter, interventional, noncontrolled clinical trial. They underwent pars plana vitrectomy with a single 24-gray dose of epimacular brachytherapy (EMB) delivered with an intraocular handheld cannula containing a strontium 90/yttrium 90 source positioned over the active lesion. Participants were retreated with ranibizumab administered monthly as needed, using predefined retreatment criteria. They underwent FFA at baseline, month 1 and month 12 and OCT at baseline and then monthly for 12 months. The FFA and OCT images were evaluated by independent, central reading facilities. Change in OCT centerpoint thickness and angiographic lesion size 12 months after EMB was the main outcome measure.
It was reported that mean centerpoint thickness increased by 50 µm, from 186 µm to 236 µm (p=0.292), but 70% of participants had an increase of less than the mean, with a median increase of only 1.8 µm. It was also noted that the FFA total lesion size increased slightly by 0.79 mm², from 14.69 to 15.48 mm² (p=0.710). Total choroidal neovascularization (CNV) area increased by 1.17 mm², from 12.94 to 14.12 mm² (p=0.556). The classic CNV area decreased substantially by 3.70 mm², from 3.90 to 0.20 mm² (p<0.01). Predominantly classic lesions showed the greatest response, with mean Early Treatment Diabetic Retinopathy Study visual acuity improving by 1.5 letters (versus −4.0 for all participants combined); mean centerpoint thickness decreased by 43 µm (p=0.875). The angiographic and OCT response did not correlate with lesion size at baseline.
To conclude, in chronic, active, neovascular AMD, EMB is associated with nonsignificant changes in centerpoint thickness and FFA total lesion size over 12 months.