Article ; Online: Microvascular abnormalities and long-term efficacy after stereotactic radiotherapy under continued intravitreal anti-VEGF treatment for neovascular AMD.
The British journal of ophthalmology
2020 Volume 106, Issue 3, Page(s) 415–421
Abstract: Background: For treatment of neovascular age-related macular degeneration (nAMD), multiple intravitreal injections of drugs targeting vascular endothelial growth factors (VEGF) result in a high burden for patients and healthcare systems. Low-energy ... ...
| Abstract | Background: For treatment of neovascular age-related macular degeneration (nAMD), multiple intravitreal injections of drugs targeting vascular endothelial growth factors (VEGF) result in a high burden for patients and healthcare systems. Low-energy stereotactic radiotherapy (SRT) might reduce the anti-VEGF need. This study evaluated the long-term efficacy and safety of adjunct SRT to anti-VEGF injections in a treat-and-extend regimen in nAMD. Methods: 50 consecutive patients were followed 3 years after single-session SRT, a safety analysis including standardised study imaging, and a reading centre based image analysis was performed after 2 years. Results: After increase from baseline (4.24±0.66 weeks) to 12 months (7.52±3.05 weeks, p<0.001), mean recurrence-free anti-VEGF treatment interval remained stable at 24 (7.40±3.17, p=0.746) and 36 months (6.89±3.00, p=0.175). Mean visual acuity change was -5.8±15.9 and -11.0±20.1 letters at 24 and 36 months, respectively. 36% of eyes showed microvascular abnormalities (MVAs) on colour fundus photography and/or fluoresceine angiography most frequently located in parafoveal inferior and nasal regions. Conclusion: In real life, low-energy SRT was associated with a reduced anti-VEGF injection frequency through year 3. However, due to an observed visual acuity reduction and remarkable number of MVAs, a close follow-up of these patients is recommended. The real-life use, optimal treatment schedule and dose should be rediscussed critically. |
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| MeSH term(s) | Angiogenesis Inhibitors/therapeutic use ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Ranibizumab/therapeutic use ; Recombinant Fusion Proteins ; Treatment Outcome ; Vascular Endothelial Growth Factor A ; Visual Acuity ; Wet Macular Degeneration/diagnosis ; Wet Macular Degeneration/drug therapy ; Wet Macular Degeneration/radiotherapy |
| Chemical Substances | Angiogenesis Inhibitors ; Recombinant Fusion Proteins ; Vascular Endothelial Growth Factor A ; Ranibizumab (ZL1R02VT79) |
| Language | English |
| Publishing date | 2020-12-21 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 80078-8 |
| ISSN | 1468-2079 ; 0007-1161 |
| ISSN (online) | 1468-2079 |
| ISSN | 0007-1161 |
| DOI | 10.1136/bjophthalmol-2020-317563 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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