Role of radiotherapy in age-related macular degeneration: A prospective study

Aim: To determine the effect of external beam radiotherapy on subfoveal cho roidal neovascularization in age-related macular degeneration. Patients and Methods: Between September 1995 and July 1996, 40 patients (9 males and 31 females; mean age 74 years, range 61 to 83 years) were include d in a prospective study. Eight patients had classic, well defined neovascu larisations, 32 patients had occult lesions. Complete ophthalmic investigat ions included visual acuity contrast sensitivity as well as fluorescein and indocyanine green angiographic examinations prior to treatment and 1, 3, 6 , and 12 months after radiotherapy. External beam radiotherapy (8-MV photon s) was delivered with a total dose of 14.4 Gy in 8 fractions of 1.8 Gy per day (Figures 1 and 2). The field size averaged 5.5 x 4.5 cm. Results: No treatment related morbidity during or after treatment was obtai ned. After 6 months follow-up the visual acuity was improved in 2 (5%) pati ents and maintained at pretreatment level in 17 (42%) patients. However, 12 months post treatment a stable situation was found in 6 (15%) patients and a decrease in visual acuity in 34 (85%) patients (Table 1). The central vi sual fields deteriorated significantly from 16.5 decibel (dB) to 12.4 dB. T he enlargement of exsudats and neovascular membranes increased 5- to 7-fold . At 12 months after treatment, 3 (7.5%) patients stated that they had impr oved vision subjectively, 12 (30%) patients had no change and 25 (62.5%) pa tients suffered from subjective decrease in visual acuity. Conclusions: Using a total dose of 14.4 Gy/1.8 Gy no difference concerning visual acuity and exsudative changes in comparison to the natural history o n age-related macular degeneration was obtained after 12 months. However, t he results of multicenter studies are to be awaited.