[Proton therapy of occult neovessels in age-related macular degeneration].
BACKGROUND
The interest of radiation therapy in the management of age-related macular degeneration inaccessible to photocoagulation is still controversial. Our purpose was to demonstrate the feasibility and the possible efficacy of a single dose delivered to the macular region using a 65-MeV proton beam.


METHODS
A phase II trial was set up using the cyclotron in Nice, France. Fifty-eight patients were included after signing an informed consent. All patients presented with occult subfoveal choroidal neovascularization. A single dose of 9.1 Gy (i.e., 10 Gy cobalt equivalent) was delivered to the macular region.


RESULTS
The results were analyzed 3, 6, 12 and, 18 months after proton therapy. At 3 months, the visual acuity was stable or enhanced for 86% of patients, at 6 months for 82.3%, at 12 months for 80%, and at 18 months for 61%. For 22 patients at follow-up at 18 months, the reasons for a decrease in visual acuity were a macular hemorrhage for 4 patients and a progression of the neovascular membrane for 3 patients. No secondary effects related to the treatment have been observed. Regarding the lesions visible on the angiographies (i.e., hemorrhage, exudates, subretinal detachment), we observed a stabilization or a decrease in two-thirds of the cases.


CONCLUSIONS
Preliminary results of single-dose proton therapy are at least comparable to those obtained by other teams. A second study is in progress comparing 3 dose levels, looking for a dose-effect relationship. Furthermore, a randomized study comparing a single proton dose to a placebo will be necessary to assess the long-term value of proton treatment.
Zur
C
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Service d'ophtalmologie, Hôpital Saint Roch, 5, rue Pierre Dévoluy, 06000 Nice.
Caujolle
J P
JP
Chauvel
P
P
Darmon
J
J
Iborra-Brassart
N
N
Gastaud
P
P
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000473:pathology; D008297:Male; D061766:Proton Therapy; D015861:Retinal Neovascularization / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D011522:Protons
D011522:Protons