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    Epimacular brachytherapy not promising in wet AMD

    Nice, France—Epimacular brachytherapy does not look promising as a treatment for previously-treated neovascular age-related macular degeneration (AMD), investigators say.

    Timothy L Jackson of King’s College London, who presented a study on the therapy at the European Society of Retina Specialists 15th EURETINA Congress, expressed his disappointment at the results. “In visual acuity we didn’t establish non-inferiority, in fact the visual acuity in the radiation arm was slightly worse than that in the control arm,” he said.

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    Although anti-vascular endothelial growth factor (anti-VEGF) therapy helps most patients with neovascular AMD, not all patients benefit. The frequent injections required can be both a financial and practical burden. Researchers are therefore looking for alternative and supplementary treatments.

    In epimacular brachytherapy, patients undergo a pars plana vitrectomy before an endoscopic probe (Vidion Anti-Neovascular Therapy System, NeoVista Inc) is passed into the cavity and held over the macula, delivering a dose of 24 grays of beta radiation from a strontium-90/yttrium-90 source to the centre of the lesion for 3 to 4 minutes. The radiation tails off exponentially as you get farther from the probe.

    In this phase 3 trial across multiple sites in the United Kingdom, Dr Jackson and colleagues randomly assigned 363 people with previously treated wet AMD to this therapy in combination with the anti-VEGF drug ranibizumab, or ranibizumab alone as required (pro re nata). All patients had previously received treatment with ranibizumab. Those who had previously received treatment other than anti-VEGF, prior radiation to the head or neck or who had subfoveal scarring, diabetes or lens opacity were excluded. To be eligible, patients had to have received three consecutive monthly ranibizumab injections. In the period running up to the study they had to have two injections in the 6 months or four injections in the 12 months prior to enrolment. Patients were retreated if they had a loss of more than five letters from baseline due to wet AMD, an increase of more than 50µm in central retinal thickness from the lowest optical coherence tomography reading, new or increased haemorrhage or new neovascularisation visible on fluorescein angiography.

    Next: 'Results fell short of researchers' hopes'

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