16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a ‘radiation-first’ strategy

Moshfeghi, Andrew A; Morales-Cantón, Virgilio; Quiroz‐Mercado, Hugo; Vélez-Montoya, Raúl; Zavala-Ayala, A.; Shusterman, E. Mark; Sanislo, Steven R.; Gertner, Michael; Moshfeghi, Darius M.

doi:10.1136/bjophthalmol-2011-301222

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…This treatment directs beams from different angles relative to the target area, thereby minimising the exposure to surrounding healthy tissue, and at the same time precisely targeting the radiation energy onto the lesion. The system is designed to overcome the traditional disadvantages of external beam therapy by dividing the dose into several separate beams that pass into the eye via different locations on the sclera 132. The patient is secured in position with a head restraint and the eye is continually tracked during treatment 131.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA)

Schmidt‐Erfurth

Chong

Loewenstein³

et al. 2014

Br J Ophthalmol

513

456

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Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due to the exponential increase in life expectancy and environmental risks. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies in medicine. The wide introduction of anti-VEGF therapy has led to an overwhelming improvement in the prognosis of patients affected by neovascular AMD, allowing recovery and maintenance of visual function in the vast majority of patients. However, the therapeutic benefit is accompanied by significant economic investments, unresolved medicolegal debates about the use of off-label substances and overwhelming problems in large population management. The burden of disease has turned into a burden of care with a dissociation of scientific advances and real-world clinical performance. Simultaneously, ground-breaking innovations in diagnostic technologies, such as optical coherence tomography, allows unprecedented high-resolution visualisation of disease morphology and provides a promising horizon for early disease detection and efficient therapeutic follow-up. However, definite conclusions from morphologic parameters are still lacking, and valid biomarkers have yet to be identified to provide a practical base for disease management. The European Society of Retina Specialists offers expert guidance for diagnostic and therapeutic management of neovascular AMD supporting healthcare givers and doctors in providing the best state-of-the-art care to their patients.Trial registration numberNCT01318941.

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Section: Therapeutic Strategiesmentioning

confidence: 99%

Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA)

Schmidt‐Erfurth

Chong

Loewenstein³

et al. 2014

Br J Ophthalmol

513

456

View full text Add to dashboard Cite

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“…Actual dose over the entire macula is calculated from analysis of the ocular movements during the treatment session. Radiation therapy consists of a fraction of 16 or 24 Gy delivered in approximately 15 min (about 3-5 min of X-ray exposure) over 3 equal spots in the inferior pars plana [59,70,71]. An active suction apparatus along with infrared markers tracks the eye in the X, Y, and Z planes or rotational angles.…”

Section: Low-voltage Stereotactic Radiotherapy (Srt) In Amdmentioning

confidence: 99%

Brachytherapy in Neovascular AMD

Grewal

Vajzovic

2015

Curr Ophthalmol Rep

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Neovascular age-related macular degeneration (AMD) has a complex pathophysiology, and although anti-VEGF therapy has been one of the most significant and successful advances, it is not effective for all patients with neovascular AMD. The potential role of radiation in the management of neovascular AMD has been suggested for several years. While previous work focused on the role of radiation alone, recent trials have evaluated the role of ionizing radiation as a synergistic treatment with anti-VEGF drugs, with endpoints being to reduce choroidal neovascular lesions faster, preserve visual acuity, and extend the treatment interval between injections. We review the current evidence available for the safety and efficacy of radiation in conjunction with anti-VEGF treatment for neovascular AMD delivered using three approaches-epimacular brachytherapy involving a pars plana vitrectomy (Vidion Neovista, Inc., Newark, CA, USA), episcleral brachytherapy without a pars plana vitrectomy (Salutaris Medical Devices, Tucson, AZ), and low-voltage stereotactic radiotherapy (IRay,

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“…Other investigative modalities include low-dose radiotherapy as an adjunctive treatment [81,82]; other novel mechanisms of VEGF blockade in early stages of clinical development, including sustained delivery platforms [83,84,85,86,87]; and therapeutics that target angiogenic pathways beyond VEGF [88,89,90,91,92,93,94]. Home-monitoring devices for early detection of CNV development may also allow treatment to be initiated earlier for improved outcomes [95].…”

Section: Treatment Of Neovascular Amdmentioning

confidence: 99%

Age-Related Macular Degeneration: Advances in Management and Diagnosis

Yonekawa

Miller

Kim

2015

JCM

116

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Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in older populations in industrialized nations. AMD is a late-onset deterioration of photoreceptors and retinal pigment epithelium in the central retina caused by various environmental and genetic factors. Great strides in our understanding of AMD pathogenesis have been made in the past several decades, which have translated into revolutionary therapeutic agents in recent years. In this review, we describe the clinical and pathologic features of AMD and present an overview of current diagnosis and treatment strategies.

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16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a ‘radiation-first’ strategy

Abstract: After 12 months, non-invasive, low-voltage x-ray irradiation with as needed ranibizumab rescue therapy demonstrated good safety with a visual acuity stabilising effect and reduction in retinal thickness in patients with neovascular AMD.

Cited by 14 publications

References 24 publications

Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA)

Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA)

Brachytherapy in Neovascular AMD

Age-Related Macular Degeneration: Advances in Management and Diagnosis

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