Radiotherapy for neovascular age-related macular degeneration

Abstract

Radiotherapy for neovascular age-related macular degeneration.

Persistent and Poor-Responsive Cystoid Macular Edema after Stereotactic Radiotherapy in Neovascular Age-Related Macular Degeneration: A Case Report of Three Patients

“…Like in previous studies in our three cases SRT as adjunctive therapy to intravitreal injections of anti-VEGF for nAMD provided an extension of anti-VEGF treatment interval for years 1 , 2 . After about 3 – 4 years, a considerable proportion of patients show MVA that could be attributed to SRT and are most frequently localized in the inferior parafoveal and nasal region 4 , 5 , 6 . Also in the three patients described in this report a prominent involvement of the parafoveal inferior region previously irradiated with SRT was shown.…”

“…SRT treatment, although still an experimental treatment, is known to be a safe and efficient procedure, but some long-term side effects are known. Radiation retinopathy (RR) is the most dreaded long-term complication of radiotherapy to the eye but because the SRT device delivers precisely targeted radiotherapy, and as the area of retinal exposure is extremely small a larger area of RR is not expected to develop 4 , 5 , 6 .…”

“…However, microvascular abnormalities (MVAs) are a sign of ionizing radiation damage, with an incidence of 36% in patients treated with SRT at 2 years 4 , 5 , 6 . Retinal MVA found in color fundus photography, fluorescein angiography and/or A-OCT included nerve fibre infarcts, retinal haemorrhages, microaneurysms, luminal irregularities, focal areas of capillary closure, distended (bullous) arteriolar and venular tips, telangiectatic segments, and late staining of the vessel walls 4 , 5 .…”

Ocular Therapeutics and Molecular Delivery Strategies for Neovascular Age-Related Macular Degeneration (nAMD)

“…Studies investigated external beam radiotherapy (15) and internal radiotherapy (3) (brachytherapy). In a 12 month follow up study, radiotherapy was compared with no radiotherapy or a sham treatment, and no consistent evidence on therapeutic benefit was revealed [ 198 ].…”

“…Table 4 summarizes the combination therapy of anti-VEGF agents with radiation for nAMD. In a 12 month follow-up study, comparing radiotherapy combined with anti-VEGF and anti-VEGF alone concluded that effectiveness for treating wet AMD was uncertain as to whether radiotherapy on its own, or with eye injections of anti-VEGF, was more beneficial [ 198 ].…”