Epimacular Brachytherapy for Previously Treated Neovascular Age-Related Macular Degeneration (MERLOT) A Phase 3 Randomized Controlled Trial Presented in part at: Retina Day, American Academy of Ophthalmology Annual Meeting, November 2015, Las Vegas, Nevada.

T.L. Jackson, R. Desai, A. Simpson, J.E. Neffendorf, R. Petrarca, K. Smith, J. Wittes, C. Lewis, L. Membrey, R. Haynes, M. Costen, D.H.W. Steel, A. Muldrew, U. Chakravarthy

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Abstract

Purpose To assess the safety and efficacy of epimacular brachytherapy (EMB) for patients with chronic, active, neovascular age-related macular degeneration (AMD). Design Phase 3 randomized controlled trial. Participants Patients (n = 363) with neovascular AMD already receiving intravitreal ranibizumab injections. Intervention Either pars plana vitrectomy with 24-gray EMB and ongoing pro re nata (PRN) ranibizumab (n = 224) or ongoing PRN ranibizumab monotherapy (n = 119). Main Outcome Measures The coprimary outcomes, at 12 months, were the number of PRN ranibizumab injections and Early Treatment of Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (VA). Secondary outcomes included the proportion of participants losing fewer than 15 ETDRS letters, angiographic total lesion size, choroidal neovascularization (CNV) size, and optical coherence tomography (OCT) foveal thickness. A predefined subgroup analysis tested the influence of baseline ocular characteristics on the response to EMB. Results The mean number of PRN ranibizumab injections was 4.8 in the EMB arm and 4.1 in the ranibizumab monotherapy arm (P = 0.068). The mean VA change was -4.8 letters in the EMB arm and -0.9 letters in the ranibizumab arm (95% confidence interval of difference between groups, -6.6 to -1.8 letters). The proportion of participants losing fewer than 15 letters was 84% in the EMB arm and 92% in the ranibizumab arm (P = 0.007). In the EMB arm, the mean total lesion size increased by 1.2 mm2 versus 0.4 mm2 in the ranibizumab arm (P = 0.27). The CNV size decreased by 0.5 mm2 in the EMB arm and by 1.3 mm2 in the ranibizumab arm (P = 0.27). The OCT foveal thickness decreased by 1.0 μm in the EMB arm and by 15.7 μm in the ranibizumab arm (P = 0.43). Most subgroups favored ranibizumab monotherapy, some significantly so. One participant showed retinal vascular abnormality attributed to radiation, but otherwise safety was acceptable. Conclusions These results do not support the use of EMB for chronic, active, neovascular AMD. Safety is acceptable out to 12 months, but radiation retinopathy can occur later, so further follow-up is planned.
Original languageEnglish
Pages (from-to)1287-1296
Number of pages10
JournalOphthalmology
Volume123
Issue number6
Early online date13 Apr 2016
DOIs
Publication statusEarly online date - 13 Apr 2016

Bibliographical note

cited By 2

Keywords

  • ranibizumab
  • angiogenesis inhibitor
  • strontium
  • vasculotropin A
  • VEGFA protein, human, age related macular degeneration
  • aged
  • blurred vision
  • brachytherapy
  • cataract
  • Conference Paper
  • confidence interval
  • controlled study
  • endophthalmitis
  • epimacular brachytherapy
  • fluorescence angiography
  • human
  • major clinical study
  • monotherapy
  • neovascular age related macular degeneration
  • optical coherence tomography
  • phase 3 clinical trial
  • priority journal
  • randomized controlled trial
  • retina detachment
  • retina hemorrhage
  • subretinal neovascularization
  • uveitis
  • visual acuity
  • visual acuity reduction
  • visual disorder
  • vitrectomy
  • vitreous floaters
  • vitreous hemorrhage
  • adverse effects
  • antagonists and inhibitors
  • chronic disease
  • clinical trial
  • female
  • intravitreal drug administration
  • male
  • middle aged
  • multicenter study
  • procedures
  • Radiation Injuries
  • radiation response
  • retina
  • retina macula lutea
  • salvage therapy
  • very elderly
  • wet macular degeneration, Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors
  • Brachytherapy
  • Chronic Disease
  • Female
  • Fluorescein Angiography
  • Humans
  • Intravitreal Injections
  • Macula Lutea
  • Male
  • Middle Aged
  • Ranibizumab
  • Retina
  • Salvage Therapy
  • Strontium Radioisotopes
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A
  • Vitrectomy
  • Wet Macular Degeneration

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