Original articleRadiotherapy for subfoveal choroidal neovascularization in age-related macular degeneration: a randomized clinical trial
Section snippets
Study design
The aim of our study was to report the results of an 18-month follow up of external beam radiation therapy with photons for subfoveal classic or occult CNV in ARMD.
The protocol for this prospective randomized double-masked study was approved by the Ethical Committee of the Kantonsspital St Gallen. The patients were informed in detail about their disease, the available therapeutic possibilities, and the study protocol of our investigation. Informed consent was obtained from each patient before
Patients and demographic data
A total of 161 patients were recruited. Classic CNV was diagnosed in 92 cases (57.1%), and occult CNV in 69 cases (42.9%). A total of 52 patients were randomly allocated to the control group with 1 Gy, 57 patients to the 8 Gy group, and 52 patients to the 16 Gy group. The main baseline characteristics of the patients are summarized in Table 1. Among the three groups no significant differences were present in the age and the gender of the patients, smoking habits, duration of the symptoms before
Best-corrected visual acuity
During the complete follow up, the mean number of lines lost was still less in the 8 Gy and 16 Gy groups than in the 1 Gy group. After 6 months, a positive trend was present in favor of 8 Gy and 16 Gy groups; a significant difference was present after 12 and18 months (Table 3). No significant difference in the number of lines lost was present between the 8 Gy group and the 16 Gy group during the complete follow-up examination (P = .800 after 6 months, P = .612 after 12 months, P = .461 after 18
Discussion
External beam radiation therapy in age-related macular degeneration has a long history in St Gallen and was previously performed by Bangerter and Hohl in the 1950s.33 After having treated, in a pilot study, the afflicted posterior eye of 40 patients with subfoveal classic or occult CNV with doses of 5 Gy (4 × 1.25 Gy) or 8 Gy (4 × 2 Gy),34 we started this prospective randomized double-masked study in 1994 and compared the efficacy of 8 Gy (4 × 2 Gy) and 16 Gy (4 × 4 Gy) with a control group of
References (45)
- et al.
Randomized trial of radiation for age-related macular degeneration
Am J Opthalmol
(1999) - et al.
Age-related macular degenerationlong-term results of radiotherapy for subfoveal neovascular membranes
Am J Opthalmol
(2000) - et al.
Irradiation decreases vascular prostacyclin formation with no concomitant effects on platelet thromboxane production
Lancet
(1981) - et al.
Late effects of radiation on the eye and ocular adnexa
Int J Radiation Oncol Biol Phys
(1995) - et al.
Epidemiology of age-related maculopathy
Epidemiol Rev
(1995) - et al.
Age-related macular degeneration
Surv Ophthalmol
(1988) Argon laser photocoagulation for neovascular maculopathy. Five years of results from randomized clinical trials
Arch Opthalmol
(1991)Recurrent choroidal neovascularization after laser photocoagulation for neovascular maculopathy
Arch Opthalmol
(1986)Visual outcome after laser photocoagulation for subfoveal choroidal neovascularization secondary to age-related macular degenerationthe influence of initial lesion size and initial visual acuity
Arch Opthalmol
(1994)A new standard of care for laser photocoagulation of subfoveal choroidal neovascularization secondary to age-related macular degeneration
Arch Ophthalmol
(1994)
Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with Verteporfin. Two-year results of 2 randomized clinical trials—TAP report 2
Arch Ophthalmol
Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degenerationtwo-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—Verteporfin in photodynamic therapy report 2
Am J Ophthalmol
Submacular surgery trials randomized pilot trial of laser photocoagulation versus surgery for recurrent choroidal neovascularization secondary to age-related macular degeneration
Am J Ophthalmol
Macular translocation for surgical management of subfoveal choroidal neovascularizations in patients with AMDfirst results
Graefes Arch Clin Exp Ophthalmol
Transplantation of fetal pigment epithelium in age-related macular degeneration with subfoveal neovascularization
Graefes Arch Clin Exp Ophthalmol
Age-related macular degenerationnew treatment shows promise
J Ophthalmic Nurs Technol
Transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularization
Br J Opthalmol
Gamma knife treatment of subfoveal classic neovascularization in age-related macular degenerationa pilot study
J Neurosurg
Radiation damage to endothelial cells in vitro, as judged by the micronucleus assay
Mutagenesis
Long-term results after low dose ocular irradiation for choroidal haemangiomas
Br J Ophthalmol
What is the role of radiation in the treatment of subfoveal membranesreview of radiobiologic, pathologic, and other considerations to initiate a multimodality discussion
Int J Radiat Oncol Biol Phys
Treatment of age-related subfoveal neovascular membranes by teletherapya pilot study
Br J Ophthalmol
Cited by (51)
A survey of Belgian practice for non-malignant diseases
2020, Cancer/RadiotherapieRadiation Therapy for Benign Disease: Keloids, Macular Degeneration, Orbital Pseudotumor, Pterygium, Peyronie Disease, Trigeminal Neuralgia
2020, Hematology/Oncology Clinics of North AmericaRadiotherapy indications for non-malignant diseases in 2014
2014, Cancer/RadiotherapieRadiation therapy for neovascular age-related macular degeneration
2013, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :These promising results led to 11 phase 3, randomized controlled trials (Table 2) (51-61). Several studies found statistically significant benefits in patients treated with EBRT (52, 53, 55, 56, 61), whereas others found no lasting benefit (51, 54, 57-60). Notably, some studies found significant improvements only for VA and not in terms of CNV membrane size (52, 53, 61), whereas others did not find improvements in VA overall but did find significant benefits in classic CNV regression or contrast sensitivity preservation (59, 60).
Proton Beam Irradiation for Neovascular Age-Related Macular Degeneration
2006, Ophthalmology