24-Gy Low-Voltage X-Ray Irradiation With Ranibizumab Therapy for Neovascular AMD: 6-Month Safety and Functional Outcomes

Cantón, Virgilio Morales; Quiroz‐Mercado, Hugo; Vélez-Montoya, Raúl; Lopez-Miranda, M. J.; Moshfeghi, Andrew A; Shusterman, E. Mark; Kaiser, Peter K.; Sanislo, Steven R.; Gertner, Michael; Moshfeghi, Darius M.

doi:10.3928/15428877-20111129-01

Cited by 17 publications

(12 citation statements)

References 23 publications

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“…At 6-month follow-up, the 16-and 24-Gy doses, in conjunction with baseline loading of ranibizumab, resulted in improvement in visual acuity with a decreased need for injections [59,70,79]. There were no incidences of cataract progression, radiation retinopathy, and optic neuropathy in any group [59,70,79]. At 6 months, the mean change in visual acuity was ?6.4 ± 9.8 ETDRS letters.…”

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

confidence: 87%

“…Because of this drop-off with increasing distance, the optic nerve receives approximately 2.4 Gy, and the lens only 0.56 mGy, both well below the 2 Gy cataractous threshold [59].…”

Section: Epimacular Brachytherapy (Embt) In Amdmentioning

confidence: 99%

“…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%

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

confidence: 87%

“…Because of this drop-off with increasing distance, the optic nerve receives approximately 2.4 Gy, and the lens only 0.56 mGy, both well below the 2 Gy cataractous threshold [59].…”

Section: Epimacular Brachytherapy (Embt) In Amdmentioning

confidence: 99%

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

confidence: 99%

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Brachytherapy in Neovascular AMD

Grewal

Vajzovic

2015

Curr Ophthalmol Rep

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“…Furthermore, we were able to extend our observations to a nonretinal angiogenesis model by demonstrating Nutlin-3 antiangiogenesis in a hind limb ischemia model. Epimacular and juxtascleral brachytherapy are being evaluated in clinical trials with mixed success (3,5). MDM2 inhibitors may have a more attractive side effect profile, since they do not elicit DNA damage and, with repeat administration, may even be more robust than a single radiation treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Epimacular and extraocular brachytherapy are cytokine-independent therapies that are currently being evaluated in clinical trial for NV-ARMD (3)(4)(5). Ionizing radiation induces free radicals and DNA damage to the cellular genome, ultimately leading to mobilization of the tumor suppression transcription factor p53 (6).…”

Section: Introductionmentioning

confidence: 99%

Retinal angiogenesis suppression through small molecule activation of p53

Chavala¹,

Kim²,

Tudisco³

et al. 2013

J. Clin. Invest.

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Neovascular age-related macular degeneration is a leading cause of irreversible vision loss in the Western world. Cytokine-targeted therapies (such as anti-vascular endothelial growth factor) are effective in treating pathologic ocular angiogenesis, but have not led to a durable effect and often require indefinite treatment. Here, we show that Nutlin-3, a small molecule antagonist of the E3 ubiquitin protein ligase MDM2, inhibited angiogenesis in several model systems. We found that a functional p53 pathway was essential for Nutlin-3-mediated retinal antiangiogenesis and disruption of the p53 transcriptional network abolished the antiangiogenic activity of Nutlin-3. Nutlin-3 did not inhibit established, mature blood vessels in the adult mouse retina, suggesting that only proliferating retinal vessels are sensitive to Nutlin-3. Furthermore, Nutlin-3 inhibited angiogenesis in nonretinal models such as the hind limb ischemia model. Our work demonstrates that Nutlin-3 functions through an antiproliferative pathway with conceivable advantages over existing cytokinetargeted antiangiogenesis therapies.

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Adjuvante stereotaktische niederenergetische Strahlentherapie bei exsudativer altersabhängiger Makuladegeneration (Oraya System)

et al. 2013

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With respect to the increasing number of patients and the risk and burden for patients caused by injections, a reduction in the number and frequency of injections with vascular endothelial growth factor (VEGF) inhibitors in exudative age-related macular degeneration (ARMD) is desirable. Stereotactic low-voltage x-ray irradiation seems to be a promising approach. For this purpose the Oraya system is available and has shown positive results in initial studies. Pending presentation of phase II and III study data this adjuvant irradiation should only be used in clinical trials.

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24-Gy Low-Voltage X-Ray Irradiation With Ranibizumab Therapy for Neovascular AMD: 6-Month Safety and Functional Outcomes

Abstract: A single treatment of external 24-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement in visual acuity in patients with neovascular AMD at 6 months, with no radiation-related adverse effects.

Cited by 17 publications

References 23 publications

Brachytherapy in Neovascular AMD

Brachytherapy in Neovascular AMD

Retinal angiogenesis suppression through small molecule activation of p53

Adjuvante stereotaktische niederenergetische Strahlentherapie bei exsudativer altersabhängiger Makuladegeneration (Oraya System)

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