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

BACKGROUND: For treatment of neovascular age-related macular degeneration (nAMD), multiple intravitreal injections of drugs targeting vascular endothelial growth factors (VEGF) result in a high burden for patients and healthcare systems. Low-energy stereotactic radiotherapy (SRT) might reduce the anti-VEGF need. This study evaluated the long-term efficacy and safety of adjunct SRT to anti-VEGF injections in a treat-and-extend regimen in nAMD. METHODS: 50 consecutive patients were followed 3 years after single-session SRT, a safety analysis including standardised study imaging, and a reading centre based image analysis was performed after 2 years. RESULTS: After increase from baseline (4.24±0.66 weeks) to 12 months (7.52±3.05 weeks, p<0.001), mean recurrence-free anti-VEGF treatment interval remained stable at 24 (7.40±3.17, p=0.746) and 36 months (6.89±3.00, p=0.175). Mean visual acuity change was -5.8±15.9 and -11.0±20.1 letters at 24 and 36 months, respectively. 36% of eyes showed microvascular abnormalities (MVAs) on colour fundus photography and/or fluoresceine angiography most frequently located in parafoveal inferior and nasal regions. CONCLUSION: In real life, low-energy SRT was associated with a reduced anti-VEGF injection frequency through year 3. However, due to an observed visual acuity reduction and remarkable number of MVAs, a close follow-up of these patients is recommended. The real-life use, optimal treatment schedule and dose should be rediscussed critically.

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

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of low-energy stereotactic radiotherapy (SRT) combined with anti-vascular endothelial growth factor (VEGF) treatment following a treat-and-extend regimen (TER) in wet age-related macular degeneration (AMD). PATIENTS AND METHODS: Before/after SRT, the authors compared retrospective consecutive case series of 50 patients requiring frequent anti-VEGF treatment (every 4 or 6 weeks) in wet AMD, treated with a single session of SRT and TER (same manner pre/post-SRT). Outcomes were visual acuity (VA), recurrence-free interval, and central retinal thickness (CRT). RESULTS: After SRT, CRT was reduced from baseline (407.3 µm ± 153.2 µm) to 12 months (320.2 µm ± 112.1 µm; P < .001), with statistical significance from month 2 onward. VA was stable for 12 months (64.0 letters ± 15.1 letters vs. 63.6 letters ± 16.2 letters). The mean recurrence-free interval increased from 4.24 weeks ± 0.66 weeks to 7.52 weeks ± 3.05 weeks at 12 months (P < .001). No severe side effects were observed. CONCLUSION: 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.].