THREE-YEAR SAFETY and VISUAL ACUITY RESULTS of EPIMACULAR (90)STRONTIUM/(90)YTTRIUM BRACHYTHERAPY WITH BEVACIZUMAB for the TREATMENT of SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION

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dc.contributor.authorAvila, Marcos P.
dc.contributor.authorFarah, Michael E. [UNIFESP]
dc.contributor.authorSantos, Arturo
dc.contributor.authorCarla, Livia
dc.contributor.authorFuji, Gildo [UNIFESP]
dc.contributor.authorRossi, Juliana [UNIFESP]
dc.contributor.authorNau, Jeffrey
dc.contributor.institutionFed Univ Goiana
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionMed Ctr Puerta de Hierro
dc.contributor.institutionNeoVista Inc
dc.date.accessioned2016-01-24T14:17:45Z
dc.date.available2016-01-24T14:17:45Z
dc.date.issued2012-01-01
dc.description.abstractPurpose: To evaluate the long-term safety and visual acuity outcomes associated with epimacular strontium 90 brachytherapy combined with intravitreal bevacizumab for the treatment of subfoveal choroidal neovascularization because of age-related macular degeneration.Methods: Thirty-four treatment-naive patients with predominantly classic, minimally classic, and occult subfoveal choroidal neovascularization lesions participated in this prospective, 2-year, nonrandomized multicenter study. Subjects from 1 center (n = 19) were reconsented and followed-up for 3 years. Each subject received a single 24-Gy beta irradiation treatment via an intraocular delivery device and 2 planned injections of bevacizumab at treatment and 1 month later. Additional bevacizumab therapy was permitted based on prespecified retreatment criteria. Adverse events were observed, and best-corrected visual acuity was measured using Early Treatment Diabetic Retinopathy Study vision charts. Subjects were evaluated every 3 months during the first year of follow-up and every 6 months during Years 2 and 3 of follow-up.Results: All 34 subjects were followed-up for 24 months and 19 were followed-up through 36 months. With up to 24 months of follow-up, 12 of 24 phakic patients (50%) exhibited >= 2 grades of progression in Lens Opacification Classification System (LOCS) II lens classification; 5 eyes underwent cataract extraction before the Month 36 visit. There was 1 case of nonproliferative retinopathy identified at 36 months of follow-up that did not have an adverse effect on visual acuity, was stable at 43 months of follow-up, and was isolated to the parafoveal region. Mean best-corrected visual acuity demonstrated an average gain of +15.0 and -4.9 letters at 12 months and 24 months, respectively; the drop in mean gain at Month 24 was largely attributable to cataract formation. At 36 months (n = 19), the mean best-corrected visual acuity was +3.9, 90% (17 of 19) of eyes had lost <15 letters from baseline, 53% (10 of 19) had gained >= 1 letter, and 21% (4 of 19) had gained >= 15 letters. Through 36 months, 11 eyes required additional bevacizumab retreatment therapy and received a mean of 3.0 injections (range, 2-7 injections).Conclusion: Epimacular brachytherapy shows promise as a therapeutic option for subfoveal neovascular age-related macular degeneration. the procedure was safe and well tolerated, with a reasonable risk-benefit profile that warrants further study in larger subject populations. the most common adverse event was cataract progression/formation. Surgical complications are similar to those expected from standard vitrectomy trials. This novel device is currently being evaluated in two prospective, randomized, controlled trials in treatment-naive subjects (CABERNET) and in subjects already treated with anti-vascular endothelial growth factor therapy (MERLOT). RETINA 32:10-18, 2012en
dc.description.affiliationFed Univ Goiana, CBCO, Goiania, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, Brazil
dc.description.affiliationMed Ctr Puerta de Hierro, Ctr Med & Surg Retina, Guadalajara, Jalisco, Mexico
dc.description.affiliationNeoVista Inc, Newark, CA USA
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent10-18
dc.identifierhttp://dx.doi.org/10.1097/IAE.0b013e31822528fc
dc.identifier.citationRetina-the Journal of Retinal and Vitreous Diseases. Philadelphia: Lippincott Williams & Wilkins, v. 32, n. 1, p. 10-18, 2012.
dc.identifier.doi10.1097/IAE.0b013e31822528fc
dc.identifier.issn0275-004X
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/34482
dc.identifier.wosWOS:000298661800003
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofRetina-the Journal of Retinal and Vitreous Diseases
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectage-related macular degenerationen
dc.subjectsubfoveal choroidal neovascularizationen
dc.subjectepiretinal brachytherapyen
dc.subjectbevacizumaben
dc.subjectradiationen
dc.subjectanti-VEGF therapyen
dc.subjectcombination therapyen
dc.titleTHREE-YEAR SAFETY and VISUAL ACUITY RESULTS of EPIMACULAR (90)STRONTIUM/(90)YTTRIUM BRACHYTHERAPY WITH BEVACIZUMAB for the TREATMENT of SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATIONen
dc.typeinfo:eu-repo/semantics/article
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