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The success of anti-VEGF monotherapy for neovascular age-related macular degeneration (AMD) has set new standards by which all new AMD therapies must be evaluated. Any new treatment for choroidal neovascularisation (CNV) due to AMD must be better than the current anti-VEGF agents, ranibizumab or bevacizumab, demonstrated either by significantly improved efficacy (ie, higher rates of visual improvement) or by a safer and/or more convenient mode of delivery. Combinations of therapies must also be evaluated according to these criteria.
In this issue of the BJO, Ávila and coauthors (see page 305) present the 12-month results of a study investigating the application of epiretinal radiation therapy in combination with bevacizumab for neovascular age-related macular degeneration.1 Early data on radiation as a treatment for choroidal neovascularisation were reported in the early 1990s.2 Subsequently, randomised trials utilising conventional external beam radiation at low doses were performed with disappointing results.3–4 Additionally, other studies of external beam irradiation using higher doses, various sources of brachytherapy and proton beam irradiation revealed conflicting results.6–11 The development of an intraocular strontium-90 applicator enabling delivery to a small volume of tissue involving the CNV complex has given new life to the idea of radiation treatment for CNV.
Unlike the prior studies of other radiation modalities, this trial evaluates radiation in combination with the anti-VEGF …