title: Macular epiretinal brachytherapy in treated age-related macular degeneration (MERITAGE): month 24 safety and efficacy results.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of epimacular brachytherapy for the treatment of chronic, active neovascular age-related macular degeneration.
  
  
  METHODS
  A prospective, multicenter, interventional noncontrolled clinical trial recruited 53 participants with previously treated neovascular age-related macular degeneration. Participants underwent pars plana vitrectomy with a single 24 Gray dose of epimacular brachytherapy, delivered using an intraocular cannula containing a Strontium 90/Yttrium 90 source that was positioned over the active lesion. Participants were retreated with ranibizumab, administered monthly as needed, using predefined retreatment criteria. Coprimary outcomes at 24 months were the proportion of participants losing <15 Early Treatment of Diabetic Retinopathy Study letters and mean number of ranibizumab retreatments.
  
  
  RESULTS
  Over 24 months, 68.1% lost <15 letters with a mean of 8.7 ranibizumab retreatments. Mean change in visual acuity was -6.3 (standard deviation, 18.9) letters. There was one case of nonproliferative radiation retinopathy.
  
  
  CONCLUSIONS
  The apparent reduction in ranibizumab retreatment was less evident in Year 2 than Year 1, with the moderate reduction in visual acuity extending into the second year. Although radiation retinopathy occurred in one case, it was not vision threatening and safety remained acceptable.
authors.affiliation: *Department of Ophthalmology, King's College Hospital, London, United Kingdom; †King's College London, London, United Kingdom; ‡Retinal Consultants of Arizona, Phoenix, Arizona; §Retina Institute of Hawaii, Honolulu, Hawaii; ¶Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; **Rabin Medical Center, Tel Aviv, Israel; and ††NeoVista, Newark, California. J. Nau is now an employee at Genentech, South San Francisco, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Petrarca
authors.forename: Pravin U
authors.initials: PU
authors.lastname: Dugel
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett
authors.forename: Adiel
authors.initials: A
authors.lastname: Barak
authors.forename: Dov
authors.initials: D
authors.lastname: Weinberger
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nau
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Jackson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001918:Brachytherapy; D002908:Chronic Disease; D019773:Epiretinal Membrane / Q000532:radiotherapy*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D000069579:Ranibizumab; D013326:Strontium Radioisotopes / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D013326:Strontium Radioisotopes; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D015021:Yttrium Radioisotopes; D000069579:Ranibizumab