Low-Energy Stereotactic Radiotherapy for Treatment of Exudative Age-Related Macular Degeneration in a Treat-and-Extend Regimen

Abstract

Low-energy SRT, combined with anti-VEGF TER, was associated with reduced injection frequency and preserved VA during 12 months of follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:86-93.].

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

“…The SRT group showed a reduction of anti-VEGF treatment during the 2 years of observation [ 5 ]. The same clinical outcome was shown in a 12-month real-life analysis [ 6 ]. However, a follow-up of the INTREPID trial reported retinal microvascular abnormalities (MVA) in about 30% of eyes, 3 years after SRT [ 7 ].…”

“…This noninvasive system comprises a precision-controlled X-ray tube, a patient interface, an eye stabilizing device, an eye-tracking system, a graphical user interface, and software for treatment planning. The IRay® System [ 10 ] and the procedure in our setting have been described in full previously [ 6 ] and were approved for clinical use in Europe. Three sequential beams converged to the retina and delivering a 16-Gy dose to an area of 4 mm in diameter centered to the fovea were applied.…”

Microvascular abnormalities and long-term efficacy after stereotactic radiotherapy under continued intravitreal anti-VEGF treatment for neovascular AMD

“…All patients had a history of anti-VEGF pretreatment prior SRT (37.6±21.4 months; 26.1±2.4 anti-VEGF pretreatments; 60%/40% receiving aflibercept/ranibizumab). For detailed baseline characteristics, see Hatz et al 17 The previous to SRT used anti-VEGF TER was continued during follow-up: for 48/50 eyes follow-up was available up to 36 months after SRT, and 2/50 eyes were lost to follow-up between 24 and 36 months. All patients attended a safety visit 24±4 months (range 18-33 months) after SRT.…”

“…[7][8][9] Therefore, different adjunct treatments aiming to reduce anti-VEGF treatment frequency have been considered, such as verteporfin photodynamic therapy 10 11 or radiation therapy. [12][13][14][15][16][17] Generally, there are two types of radiotherapy being reported in nAMD: the external and the internal type. In the external type, called teletherapy, an individually conformed radiation beam of an external source is projected into the target tissue.…”

“…18 19 Stereotactic radiotherapy (SRT) is a special type of teletherapy using multiple narrow beams of radiation (kilovoltage or megavoltage) being used to target small, well-defined areas with high precision under perfect positioning of the patient and using navigational systems as frames or imaging, such as the IRay System (Carl Zeiss Meditec AG Germany). [15][16][17] In the internal radiotherapy type, called epimacular brachytherapy (EMBT), a radiation source is directly placed next to the target site surgically. [12][13][14] In a few studies, EMBT combined with anti-VEGF injections led to a reduction of anti-VEGF retreatments, [12][13][14] while another study failed to show superiority of EMBT regarding fewer injections.…”