Stereotactic radiotherapy in neovascular age-related macular degeneration

Abstract

Stereotactic radiotherapy (SRT) is a new approach to treat neovascular age-related macular degeneration (nAMD). The INTREPID trial suggested that SRT could reduce the frequency of regular intravitreal injections (IVIs) with antivascular endothelial growth factor drugs, which are necessary to control disease activity. However, the efficacy of SRT in nAMD and resulting morphological changes have not been validated under real-life circumstances, an issue, which we would like to address in this retrospective analysis.Patients who met the INTREPID criteria for best responders were eligible for SRT. A total of 32 eyes of 32 patients were treated. Thereafter, patients were examined monthly for 12 months and received pro re nata IVI of aflibercept or ranibizumab. Outcome measures were: mean number of injections, best-corrected visual acuity, and morphological changes of the outer retina-choroid complex as well as patient safety.Mean number of IVI decreased by almost 50% during the 12 months after SRT compared to the year before, whereas visual acuity increased by one line (logMAR). Morphological evaluation showed that most changes affect outer retinal layers.Stereotactic radiotherapy significantly reduced IVI retreatment in nAMD patients under real-life circumstances. Therefore, SRT might be the first step to stop visual loss as a result of IVI undertreatment, which is a major risk.

Polypoidal Choroidal Vasculopathy after Stereotactic Radiotherapy for Neovascular Age-Related Macular Degeneration: A Case Report with Long-Term Follow-Up

“…For the current case, we report the extension of anti-VEGF treatment intervals during the first 2 years following adjunct SRT with stable VA. This corresponds to the findings of the INTREPID trial as well as a few real-life analyses [ 5 , 6 , 10 , 11 , 12 ]. However, like several patients in a real-life case series [ 8 ], our patient experienced the necessity of shortening of anti-VEGF treatment intervals in the third year after SRT.…”

IRay therapy as an adjuvant therapy in newly diagnosed patients with neovascular age-related macular degeneration

“…3 shows that the number of subjects in the IRay group that didn’t require further injections following the loading phase was nearly double that of the control group (45.5 vs. 24.0%, P = 0.005). While the IRay group likely contained responders to anti-VEGF therapy, the additional 21.5% of patients requiring no further injection is similar to the 33% of patients in the best-responding subgroup of INTREPID and the 25% of patients in a real life study of patient’s pre-verses post-IRay therapy [8, 13].…”

Recent developments in age-related macular degeneration: a review

“…Other treatment modalities under investigation include the role of adjunctive treatments alongside anti-VEGF by stereotactic radiotherapy (ie, use of a low-voltage external beam) to reduce the frequency of intravitreal injections needed while maintaining VA. 175 , 176 Ranjbar et al 177 demonstrated that the mean number of intravitreal injections was reduced by almost 50% during the 12 months after stereotactic radiotherapy compared to the number required the year before and that VA increased by one line (logMAR). Other promising therapeutic approaches are modulators of angiogenesis.…”