Macular Epiretinal Brachytherapy in Treated Age-related Macular Degeneration (MERITAGE): Month 12 Optical Coherence Tomography and Fluorescein Angiography

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• 作者：Robert Petrarca ; MBBS¹ ; ² ; Pravin U. Dugel ; MD³ ; Jeffrey Nau ; MMS³ ; ⁴ ; Jason S. Slakter ; MD⁵ ; Glenn J. Jaffe ; MD⁶ ; Timothy L. Jackson ; PhD ; FRCOphth¹ ; ² ; ^{t.jackson1@nhs.net}
• 刊名：Ophthalmology
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：120
• 期：2
• 页码：328-333
• 全文大小：539 K

文摘

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Purpose

To report the optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) results of the Macular Epiretinal Brachytherapy in Treated Age-Related Macular Degeneration study.

Design

Prospective, multicenter, interventional, noncontrolled clinical trial.

Participants

Fifty-three eyes of 53 participants with chronic, active neovascular age-related macular degeneration (AMD) requiring frequent anti-vascular endothelial growth factor retreatment.

Methods

Participants underwent pars plana vitrectomy with a single 24-gray dose of epimacular brachytherapy (EMB), delivered with an intraocular, handheld, cannula containing a strontium 90/yttrium 90 source positioned over the active lesion. Participants were retreated with ranibizumab administered monthly as needed, using predefined retreatment criteria. Patients underwent FFA at baseline, month 1, and month 12. Patients underwent optical coherence tomography (OCT) at baseline and then monthly for 12 months. The FFA and OCT images were evaluated by independent, central reading facilities.

Main Outcome Measures

Change in OCT centerpoint thickness and angiographic lesion size 12 months after EMB.

Results

Mean centerpoint thickness increased by 50 ¦Ìm, from 186 to 236 ¦Ìm (P = 0.292), but 70 % of participants had an increase of less than the mean, with a median increase of only 1.8 ¦Ìm. The FFA total lesion size increased slightly by 0.79 mm², from 14.69 to 15.48 mm² (P = 0.710). Total choroidal neovascularization (CNV) area increased by 1.17 mm², from 12.94 to 14.12 mm² (P = 0.556). The classic CNV area decreased substantially by 3.70 mm², from 3.90 to 0.20 mm² (P<0.01). Predominantly classic lesions showed the greatest response, with mean Early Treatment Diabetic Retinopathy Study visual acuity improving by 1.5 letters (versus ?4.0 for all participants combined); mean centerpoint thickness decreased by 43 ¦Ìm (P = 0.875). The angiographic and OCT response did not correlate with lesion size at baseline.

Conclusions

In chronic, active, neovascular AMD, EMB is associated with nonsignificant changes in centerpoint thickness and FFA total lesion size over 12 months.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.