title: Proton beam irradiation for neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate safety and visual outcomes after proton therapy for subfoveal neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Randomized dose-ranging clinical trial.
  
  
  METHODS
  One hundred sixty-six patients with angiographic evidence of classic choroidal neovascularization resulting from AMD and best-corrected visual acuity of 20/320 or better.
  
  
  METHODS
  Patients were assigned randomly (1:1) to receive 16-cobalt gray equivalent (CGE) or 24-CGE proton radiation in 2 equal fractions. Visual acuity was measured using standardized protocol refraction. Complete ophthalmological examinations, color fundus photography, and fluorescein angiography were performed before and 3, 6, 12, 18, and 24 months after treatment.
  
  
  METHODS
  Proportion of eyes losing 3 or more lines of vision from baseline. Kaplan-Meier statistics were used to compare cumulative rates of vision loss between the 2 treatment groups.
  
  
  RESULTS
  At 12 months after treatment, 36 eyes (42%) and 27 eyes (35%) lost 3 or more lines of vision in the 16-CGE and 24-CGE groups, respectively. Rates increased to 62% in the 16-CGE group and 53% in the 24-CGE group by 24 months after treatment (P = 0.40). Radiation complications developed in 15.7% of patients receiving 16 CGE and 14.8% of patients receiving 24 CGE.
  
  
  CONCLUSIONS
  No significant differences in rates of visual loss were found between the 2 dose groups. Proton radiation may be useful as an adjuvant therapy or as an alternative for patients who decline or are not appropriate for approved therapies.
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Hadi J
authors.initials: HJ
authors.lastname: Zambarakji
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lane
authors.forename: Eric
authors.initials: E
authors.lastname: Ezra
authors.forename: Danny
authors.initials: D
authors.lastname: Gauthier
authors.forename: Michael
authors.initials: M
authors.lastname: Goitein
authors.forename: Judy A
authors.initials: JA
authors.lastname: Adams
authors.forename: John E
authors.initials: JE
authors.lastname: Munzenrider
authors.forename: Joan W
authors.initials: JW
authors.lastname: Miller
authors.forename: Evangelos S
authors.initials: ES
authors.lastname: Gragoudas
mesh_terms: D000368:Aged; D020256:Choroidal Neovascularization / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D009900:Optic Nerve; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012164:Retinal Diseases / Q000209:etiology; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity