RADIATION-THERAPY FOR MACULAR DEGENERATION - TECHNICAL CONSIDERATIONSAND PRELIMINARY-RESULTS

Purpose: This study was undertaken to assess the toxicity and possible benefits from the administration of low-dose external-beam irradiatio n for Age-Related Macular Degeneration (ARMD), The premise of the trea tment is that radiation induces regression and/or promotes inactivatio n of the subretinal neo-vasculature, resulting in reabsorption of flui d and blood thus reducing the risk for further leakage or bleeding, as well as subretinal fibrosis. Clinically, the beneficial effect could be translated into stabilization of visual acuity and prevention of pr ogression of the wet type of ARMD with the possibility for some visual improvement, Methods and Materials: Allegheny University Hospitals, H ahnemann, Department of Radiation Oncology, treated 278 patients prosp ectively beginning in January 1995 with low-dose irradiation for wet-t ype macular degeneration, Two hundred forty-nine patients were treated with a total dose of 14.40 Gy in eight fractions of 1.80 Gy over 10-1 3 elapsed days, and 27 patients with 20 Gy at 2 Gy per fraction over 1 2-15 days, The first two patients were treated to a total dose of 10.0 0 Gy in five fractions of 2.00 Gy, Patients were evaluated at 2-3 week s and 2-3 months, A percentage (36.7%) of the patients had previously received laser treatments in the study eye, 21.9% once, 5% twice, 9.7% three or more, Subjective visual acuity and toxicity data was collect ed on all patients, Results: At 2-3 weeks after treatment 195 patients (70%) retained their visual acuity without change, 68 patients (24.5% ) stated they had improved vision, and 15 patients (4.8%) stated their vision continued to decrease, Two to 3 months after treatment, 183 pa tients (65.8%) had no change in their vision, 75 patients (27%) patien ts had an improvement in their vision, and 20 patients (7.2%) had a de crease in visual acuity, Transient acute reactions occurred in 14 of t he 278 patients treated, Conclusion: Our observations in this group of 278 patients support the conclusion that many patients will have impr oved or stable vision after treatment with low-dose irradiation for ag e related wet type macular degeneration, (C) 1997 Elsevier Science Inc .