Brachytherapy in Neovascular AMD

Abstract

Neovascular age-related macular degeneration (AMD) has a complex pathophysiology, and although anti-VEGF therapy has been one of the most significant and successful advances, it is not effective for all patients with neovascular AMD. The potential role of radiation in the management of neovascular AMD has been suggested for several years. While previous work focused on the role of radiation alone, recent trials have evaluated the role of ionizing radiation as a synergistic treatment with anti-VEGF drugs, with endpoints being to reduce choroidal neovascular lesions faster, preserve visual acuity, and extend the treatment interval between injections. We review the current evidence available for the safety and efficacy of radiation in conjunction with anti-VEGF treatment for neovascular AMD delivered using three approaches—epimacular brachytherapy involving a pars plana vitrectomy (Vidion Neovista, Inc., Newark, CA, USA), episcleral brachytherapy without a pars plana vitrectomy (Salutaris Medical Devices, Tucson, AZ), and low-voltage stereotactic radiotherapy (IRay, Oraya Therapeutics, Inc., Newark, CA, USA).