Long term results of radiotherapy for subfoveal choroidal neovascularisation in age related macular degeneration.
OBJECTIVE
Radiotherapy has been proposed as an alternative treatment for patients with subfoveal choroidal neovascularisation (CNV) that is untreatable according to macular photocoagulation study guidelines. This prospective study was designed to evaluate whether radiotherapy may affect the functional and anatomical outcome in a large cohort of patients affected by subfoveal CNV, with a follow up period up to 24 months.


METHODS
212 patients (231 eyes) with newly diagnosed subfoveal CNV not amenable to laser therapy were included in this study. Two radiotherapy methods, the lateral beam technique (6 MV, 20 Gy in five fractions) and lateral arc therapy (25 MV, 16 to 20 Gy, in four or five fractions), were used. Comparisons of best corrected visual acuity (VA), fluorescein (FA) and indocyanine green (ICG) angiography, at inclusion and 6, 12, 18, and 24 months after radiotherapy were performed using univariate analysis.


RESULTS
A VA improvement of two or more lines was observed in 34% at 12 months, 31% at 18 months, and 32% of the eyes at 24 months. Paired comparisons of CNV areas in FA and ICG showed no significant change between baseline and each visit. However, 12 and 18 months after treatment, 47% of the eyes showed a decrease of 10% or more in CNV size both in ICG and FA. Radiation side effects included radiation retinopathy (eight eyes), optic neuropathy (four eyes), choroidal vasculopathy (five eyes), and branch retinal vein occlusion (three eyes).


CONCLUSIONS
Compared with the natural course of subfoveal CNV, the results of this prospective study suggest that radiotherapy could stabilise visual and anatomical outcome in selected cases.
Centre d'Imagerie et de Laser, Lyons, France.
M
M
Mauget-Faÿsse
C
C
Chiquet
D
D
Milea
P
P
Romestaing
J P
JP
Gérard
P
P
Martin
F
F
Koenig
D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005584:Fovea Centralis; D006801:Humans; D008268:Macular Degeneration / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D015861:Retinal Neovascularization / Q000532:radiotherapy*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology