title: 16-Gy low-voltage x-ray irradiation followed by as-needed ranibizumab therapy for AMD: 6-month outcomes of a "radiation-first" strategy.
abstract: OBJECTIVE
  To describe the effect of a "radiation-first" combination treatment strategy for neovascular age-related macular degeneration (AMD) with ranibizumab rescue therapy.
  
  
  METHODS
  Non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 16 Gy was given in a single session through three locations in the inferior pars plana in a consecutive series of patients with neovascular AMD. Ranibizumab was administered according to prospectively determined criteria.
  
  
  RESULTS
  Thirteen patients completed a 6-month follow-up. All patients lost 15 or fewer ETDRS letters, 7 gained 0 or more ETDRS letters, and 0 gained more than 15 ETDRS letters. Patients received a total of 15 ranibizumab injections following x-ray irradiation at baseline. Two patients received no ranibizumab injections, seven patients received 1 injection, and four patients received 2 injections.
  
  
  CONCLUSIONS
  Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Department of Ophthalmology, Palm Beach Gardens, Florida, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Moshfeghi
authors.forename: Virgilio Morales
authors.initials: VM
authors.lastname: Canton
authors.forename: Hugo
authors.initials: H
authors.lastname: Quiroz-Mercado
authors.forename: Raul
authors.initials: R
authors.lastname: Velez-Montoya
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Lopez-Miranda
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Shusterman
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.forename: Steven R
authors.initials: SR
authors.lastname: Sanislo
authors.forename: Michael
authors.initials: M
authors.lastname: Gertner
authors.forename: Darius M
authors.initials: DM
authors.lastname: Moshfeghi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab; D016879:Salvage Therapy / Q000379:methods; D014792:Visual Acuity; D014964:X-Ray Therapy / Q000379:methods*
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab