External radiotherapy in macular degeneration: Technique and preliminary subjective response

Freire, Jorge E.; Longton, Wallace A.; Miyamoto, Curtis; Brady, Luther W.; Augsburger, James J.; Brown, Gary C.; Micaily, Bizhan; Unda, Ricardo

doi:10.1016/s0360-3016(96)00428-2

Cited by 54 publications

(10 citation statements)

References 10 publications

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“…In the largest case series reported previously, Finger et al 17 used external beam irradiation (12)(13)(14)(15) Gy in fractions of 1.8 Gy) and palladium 103 plaque brachytherapy in 22 and two recurrent CNV eyes, respectively. Fifty eight percent of eyes showed ophthalmoscopic/angiographic stabilisation or improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Visual acuity in the 8 Gy eye decreased from 20/500 to 20/1600, whereas acuity improved from 20/100 to 20/40 in the 14 Gy eye 21. Finally, 1515 and 1831 …”

mentioning

confidence: 96%

“…Some uncontrolled, non-randomised studies report minimal or no therapeutic external beam irradiation effect, [11][12][13] whereas others report a moderate benefit with standard fractions. [14][15][16][17] Higher fractions and doses of external beam irradiation 18 and other modalities such as brachytherapy 17 19 or proton beam irradiation 20 21 have also been examined. Some evidence of angiographic regression of CNV has been observed with higher fractions, especially after proton beam irradiation, but radiation retinopathy rates are significant.…”

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confidence: 99%

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Radiotherapy for recurrent choroidal neovascularisation complicating age related macular degeneration

Marcus

Sheils

Young

et al. 2004

British Journal of Ophthalmology

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Section: Discussionmentioning

confidence: 99%

“…Visual acuity in the 8 Gy eye decreased from 20/500 to 20/1600, whereas acuity improved from 20/100 to 20/40 in the 14 Gy eye 21. Finally, 1515 and 1831 …”

mentioning

confidence: 96%

mentioning

confidence: 99%

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Radiotherapy for recurrent choroidal neovascularisation complicating age related macular degeneration

Marcus

Sheils

Young

et al. 2004

British Journal of Ophthalmology

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“…No eYcacious treatment for the subfoveal neovascularisation and its associated subretinal haemorrhage has been available. [4][5][6][7] Several investigators demonstrated the eYcacy and safety of low dose irradiation (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Gy) for subfoveal choroidal neovascular membranes of age related macular degeneration. [8][9][10][11][12][13][14][15][16][17][18][19][20] This study, for the first time, assesses low dose radiotherapy for subfoveal neovascular membrane and subretinal haemorrhage associated with pathologic myopia.…”

mentioning

confidence: 99%

Radiotherapy for subfoveal neovascularisation associated with pathological myopia: a pilot study

Kobayashi

Kobayashi²

2000

British Journal of Ophthalmology

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Background/aim-Limited treatments are available for this disease process. A pilot study was performed to determine the toxicity and eYcacy of external beam radiotherapy for subfoveal neovascular membranes and subretinal haemorrhage associated with pathological myopia. Methods-A randomised, prospective study was carried out on 39 patients with subfoveal neovascularisation associated with high myopia. 20 patients underwent radiotherapy and the remaining 19 were observed as a randomised comparison group. All patients were followed up for at least 24 months. Subfoveal choroidal neovascular membranes (CNVMs) were treated with a single lateral 6 MV photon beam to a dose of 10 Gy in five fractions over 5-7 days. Post-treatment measurements included corrected visual acuity, area of CNVM, and occurrence of radiotherapy related complications, and adverse reactions. To assess changes of area of CNVM, the initial (pretreatment) size of the CNVM was set to 100%, and all post-treatment measurements were normalised relative to the initial size. Results-No significant acute morbidity was noted. There was no significant diVerence in age, sex, refractive error, visual acuity, and area of CNVM at baseline between the treatment group and control group. The mean change of the size of the CNVM for 2 years was 155% (SD 156%) in the treatment group and 249% (124%) in the control group. The increase in the size of CNVM in the treatment group was significantly smaller than that in the control group (p = 0.0452). In the treated eyes, the visual acuity before and 1 and 2 years after radiotherapy were 0.111 ( Patients with pathological myopia frequently develop slowly progressive loss of central acuity associated with myopic degenerative changes in the fifth or sixth decade.1 Fucks described a raised, circular, pigmented lesion that develops in the macula of middle aged patients (Foerster-Fucks spot).2 3 This lesion consists of a localised ingrowth of fibrovascular tissue from the choroid and proliferation of pigment epithelial cells. In addition, bleeding from the subretinal neovascular membranes causes blurring or loss of central vision. No eYcacious treatment for the subfoveal neovascularisation and its associated subretinal haemorrhage has been available. [4][5][6][7] Several investigators demonstrated the eYcacy and safety of low dose irradiation (10-20 Gy) for subfoveal choroidal neovascular membranes of age related macular degeneration. [8][9][10][11][12][13][14][15][16][17][18][19][20] This study, for the first time, assesses low dose radiotherapy for subfoveal neovascular membrane and subretinal haemorrhage associated with pathologic myopia. Subjects and methods PATIENTSPatients with high myopia were eligible for study when they had subfoveal neovascularisation. Indications for radiotherapy were (1) subfoveal choroidal neovascular membranes (CNVMs), (2) newly formed or exacerbated CNVMs, (3) visual acuity of 0.4 (80/200) or less, (4) age of 60 and over, and (5) high myopia. High myopia was defined as the presence of myopic ...

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“…Radiation side effects are mostly seen as transient epiphora or conjunctival irritation,5 6 but only four cases of permanent cataract formation have been described in these studies so far 821 22 …”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for age related macular degeneration causes transient lens transparency changes

Eter¹,

Wegener²,

Schüller³

et al. 2000

British Journal of Ophthalmology

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Aim-Evaluation of potential side eVects of photon radiotherapy on the transparency of the lens. Methods-The anterior segments of 14 phakic eyes from patients suVering from subfoveal neovascularisation as a result of age related macular degeneration (AMD) were documented by Scheimpflug photography (Topcon SL-45, Kodak Tmax 400) before the start of radiotherapy as well as 6 and 12 months afterwards. All negatives were evaluated by microdensitometry, and peak heights for distinct layers of the lens were used for statistical comparison. External beam radiotherapy (6 MeV photons) consisted of a total dose of 20 Gy, delivered as 10 fractions of 2 Gy. Results-Six and 12 months following irradiation statistical comparison of the ratios in density change of lenses from irradiated versus non-irradiated fellow eyes revealed statistically significant (p<0.05) loss of transparency of layers 5 and 7 of the nuclear region. In layer 1 (capsuloepithelial complex) the changes were close to significance. At the 12 month examination, however, all of these significant changes had disappeared. Conclusion-Six months following radiotherapy for AMD, both the anterior capsuloepithelial region and the nuclear layers showed precataractous changes. As most of these significant diVerences had disappeared after 12 months, it is obvious that these findings reflect acute radiation damage to the lens epithelial cells and an ionising eVect on the proteins of the lens nucleus. Long term studies will have to be carried out to demonstrate whether or not this acute radiation damage, which is expressed as a transient increase in light scattering of some layers of the lens, actually does lead to permanent transparency changes, thus reflecting radiation cataractogenesis, and if so, after what time interval and to what extent cataract occurs. (Br J Ophthalmol 2000;84:757-760) External beam radiotherapy has been evaluated for treatment of patients with age related macular degeneration (AMD), accompanied by subfoveal choroidal neovascularisation.

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External radiotherapy in macular degeneration: Technique and preliminary subjective response

Cited by 54 publications

References 10 publications

Radiotherapy for recurrent choroidal neovascularisation complicating age related macular degeneration

Radiotherapy for recurrent choroidal neovascularisation complicating age related macular degeneration

Radiotherapy for subfoveal neovascularisation associated with pathological myopia: a pilot study

Radiotherapy for age related macular degeneration causes transient lens transparency changes

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