Timothy L Jackson1, E Mark Shusterman, Mark Arnoldussen, Erik Chell, Kun Wang, Darius M Moshfeghi. 1. *Department of Ophthalmology, School of Medicine, King's College London, London, United Kingdom; †Oraya Therapeutics, Inc, Newark, California; ‡The International Drug Development Institute, Louvain-la-Neuve, Belgium; and §Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
Abstract
PURPOSE: To determine which patients respond best to stereotactic radiotherapy (SRT) for neovascular age-related macular degeneration. METHODS:Participants (n = 230) receivingintravitreal anti-vascular endothelial growth factor injectionsfor neovascular age-related macular degeneration enrolled in a randomized, double-masked sham-controlled trial comparing 16 Gray, 24 Gray, or Sham SRT. In a post hoc analysis, participants were grouped according to their baseline characteristics, to determine if these influenced SRT efficacy. RESULTS: At 52 weeks, SRT was most effective for lesions ≤4 mm in greatest linear dimension and with a macular volume greater than the median value of 7.4 mm. For 26% of the participants with both these characteristics, SRT resulted in 55% fewer ranibizumab injections (2.08 vs. 4.60; P = 0.0002), a mean visual acuity change that was 5.33 letters superior to sham (+2.18 vs. -3.15 letters; P = 0.0284), and a 71.1-μm greater reduction in mean central subfield thickness (-122.6 vs. -51.5 μm; P = 0.027). Other features associated with a positive response to SRT included pigment epithelial detachment and the absence of fibrosis. CONCLUSION:Stereotactic radiotherapy is most effective for neovascular age-related macular degeneration lesions that are actively leaking at the time of treatment, and no larger than the 4-mm treatment zone.
RCT Entities:
PURPOSE: To determine which patients respond best to stereotactic radiotherapy (SRT) for neovascular age-related macular degeneration. METHODS:Participants (n = 230) receiving intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration enrolled in a randomized, double-masked sham-controlled trial comparing 16 Gray, 24 Gray, or Sham SRT. In a post hoc analysis, participants were grouped according to their baseline characteristics, to determine if these influenced SRT efficacy. RESULTS: At 52 weeks, SRT was most effective for lesions ≤4 mm in greatest linear dimension and with a macular volume greater than the median value of 7.4 mm. For 26% of the participants with both these characteristics, SRT resulted in 55% fewer ranibizumab injections (2.08 vs. 4.60; P = 0.0002), a mean visual acuity change that was 5.33 letters superior to sham (+2.18 vs. -3.15 letters; P = 0.0284), and a 71.1-μm greater reduction in mean central subfield thickness (-122.6 vs. -51.5 μm; P = 0.027). Other features associated with a positive response to SRT included pigment epithelial detachment and the absence of fibrosis. CONCLUSION: Stereotactic radiotherapy is most effective for neovascular age-related macular degeneration lesions that are actively leaking at the time of treatment, and no larger than the 4-mm treatment zone.
Authors: Timothy L Jackson; Cristina Soare; Caroline Petrarca; Andrew Simpson; James E Neffendorf; Robert Petrarca; Alyson Muldrew; Tunde Peto; Usha Chakravarthy; Luke Membrey; Richard Haynes; Mark Costen; David Steel; Riti Desai Journal: JAMA Ophthalmol Date: 2020-08-01 Impact factor: 7.389
Authors: James E Neffendorf; Riti Desai; Yanzhong Wang; Joanna Kelly; Caroline Murphy; Barnaby C Reeves; Usha Chakravarthy; Sarah Wordsworth; Cornelius Lewis; Janet Peacock; Shahir Uddin; Joe M O'Sullivan; Timothy L Jackson Journal: Trials Date: 2016-11-24 Impact factor: 2.279
Authors: Efstathios Vounotrypidis; Anna Hillenmayer; Christian M Wertheimer; Alexis Athanasiou; Jakob Siedlecki; Michael Orth; Andreas Ohlmann; Siegfried G Priglinger; Armin Wolf Journal: Sci Rep Date: 2021-04-13 Impact factor: 4.379