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Real-world experience of using stereotactic radiotherapy combined with anti-vascular endothelial growth factor to treat neovascular AMD

  • Retinal Disorders
  • Published:
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Abstract

Introduction

Adjunctive treatment or longer-acting drugs are required to treat nAMD to help ease burdens for patients and hospital clinics alike. Stereotactic therapy is one such option, providing a reduction in the number of injections over time.

Objective

To determine the clinical outcomes in a cohort of patients with nAMD receiving a combination therapy of stereotactic radiotherapy (SRT) with intravitreal anti-VEGF injections (IVI).

Method

A retrospective analysis of 74 patients with nAMD, who had received IVI and SRT (16 Gray maximum dose to the macula) at a large tertiary university eye hospital, between March 2018 and September 2019 was performed. The number of IVIs, visual acuity (VA), and central retinal thickness (CRT) were evaluated at 12, 24, and 36 months after patients received SRT and compared to the same time interval prior to SRT.

Results

Follow-up data at 12, 24, and 36 months following and prior to SRT was available for 74, 48, and 22 patients respectively. Overall there was a significant reduction in the number of injections post-SRT. Twelve months following SRT, the median number of IVI was reduced by 1 (p < 0.05). The reduction in the median number of IVI was significantly reduced by 3 and 6 injections at 24- and 36-month follow-up respectively (p < 0.05). The CRT was significantly reduced post-SRT compared to the baseline values at all time periods. There was no statistically significant difference in VA at 12-month follow-up compared to baseline. The VA, however, significantly decreased at 24- and 36-month follow-up (p < 0.05).

Conclusion

A therapy combining SRT with IVI has shown an overall reduction in the number of injections required in nAMD patients at 12, 24, and 36 months following SRT compared to IVI treatment alone. These real-world outcomes are comparable to other studies while also confirming the maintenance of the reduced frequency of required IVI for patients with nAMD.

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Authors and Affiliations

  1. Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK

    Rosalind Creer, Nattapon Boonarpha, Gemma Gould, Azita Rajai & Ramandeep Chhabra

  2. Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Rosalind Creer

  3. School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Ramandeep Chhabra

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  1. Rosalind Creer
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  2. Nattapon Boonarpha
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Correspondence to Rosalind Creer.

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The authors declare no competing interests.

Ethical considerations

This SRT treatment pathway evaluation was deemed to be a service evaluation observing the standard clinical pathway without any additional intervention. The NHS Health Research Authority confirmed the status of our evaluation using the decision tool [29], and therefore, no formal ethical review was required. The use of patient data is in line with the Manchester University NHS Foundation Trust’s privacy policy [30].

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Creer, R., Boonarpha, N., Gould, G. et al. Real-world experience of using stereotactic radiotherapy combined with anti-vascular endothelial growth factor to treat neovascular AMD. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-024-06429-6

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  • DOI: https://doi.org/10.1007/s00417-024-06429-6

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