title: Macular epiretinal brachytherapy in treated age-related macular degeneration (MERITAGE): month 12 optical coherence tomography and fluorescein angiography.
abstract: OBJECTIVE
  To report the optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) results of the Macular Epiretinal Brachytherapy in Treated Age-Related Macular Degeneration study.
  
  
  METHODS
  Prospective, multicenter, interventional, noncontrolled clinical trial.
  
  
  METHODS
  Fifty-three eyes of 53 participants with chronic, active neovascular age-related macular degeneration (AMD) requiring frequent anti-vascular endothelial growth factor retreatment.
  
  
  METHODS
  Participants underwent pars plana vitrectomy with a single 24-gray dose of epimacular brachytherapy (EMB), delivered with an intraocular, handheld, cannula containing a strontium 90/yttrium 90 source positioned over the active lesion. Participants were retreated with ranibizumab administered monthly as needed, using predefined retreatment criteria. Patients underwent FFA at baseline, month 1, and month 12. Patients underwent optical coherence tomography (OCT) at baseline and then monthly for 12 months. The FFA and OCT images were evaluated by independent, central reading facilities.
  
  
  METHODS
  Change in OCT centerpoint thickness and angiographic lesion size 12 months after EMB.
  
  
  RESULTS
  Mean centerpoint thickness increased by 50 μm, from 186 to 236 μm (P = 0.292), but 70% of participants had an increase of less than the mean, with a median increase of only 1.8 μm. The FFA total lesion size increased slightly by 0.79 mm(2), from 14.69 to 15.48 mm(2) (P = 0.710). Total choroidal neovascularization (CNV) area increased by 1.17 mm(2), from 12.94 to 14.12 mm(2) (P = 0.556). The classic CNV area decreased substantially by 3.70 mm(2), from 3.90 to 0.20 mm(2) (P<0.01). Predominantly classic lesions showed the greatest response, with mean Early Treatment Diabetic Retinopathy Study visual acuity improving by 1.5 letters (versus -4.0 for all participants combined); mean centerpoint thickness decreased by 43 μm (P = 0.875). The angiographic and OCT response did not correlate with lesion size at baseline.
  
  
  CONCLUSIONS
  In chronic, active, neovascular AMD, EMB is associated with nonsignificant changes in centerpoint thickness and FFA total lesion size over 12 months.
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Petrarca
authors.forename: Pravin U
authors.initials: PU
authors.lastname: Dugel
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nau
authors.forename: Jason S
authors.initials: JS
authors.lastname: Slakter
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Jaffe
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Jackson
mesh_terms: D001918:Brachytherapy; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000532:radiotherapy*; D005451:Fluorescein Angiography; D006801:Humans; D008266:Macula Lutea / Q000473:pathology / Q000528:radiation effects*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013326:Strontium Radioisotopes / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000532:radiotherapy*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D013326:Strontium Radioisotopes; D015021:Yttrium Radioisotopes