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Epimacular brachytherapy for previously treated neovascular age-related macular degeneration (MERLOT): year 1 sub-group analysis

Session Details

Session Title: AMD III

Session Date/Time: Sunday 20/09/2015 | 11:00-13:00

Paper Time: 11:00

Venue: Athena

First Author: : J.Neffendorf UNITED KINGDOM

Co Author(s): :    T. Jackson   R. Desai           

Abstract Details

PURPOSE:To explore whether there are subgroups of patients who respond to epimacular brachytherapy (EMB) used for the treatment of chronic, active, neovascular age-related macular degeneration (AMD)


24 United Kingdom sites


A total of 363 adults with previously treated, active, neovascular AMD were randomized 2:1 to 24 Gray EMB with monthly as needed (PRN) ranibizumab, or monthly PRN ranibizumab monotherapy. The co-primary outcome measures were number of PRN ranibizumab injections and the change in Early Treatment of Diabetic Retinopathy Study best corrected visual acuity (VA), both at 12 months. A prespecified subgroup analysis was undertaken in relation to lens status, baseline VA, and angiographic lesion size and type (classic, minimally classic and occult, determined by an independent reading centre)


The following baseline ocular characteristics were associated with a better VA response to EMB: phakic lens, VA 53 letters or worse, occult lesions, and small lesions (3.5 disc areas or less). Baseline characteristics associated with fewer injections following EMB were phakic lens status, VA better than 53 letters, classic lesions, and small lesions. None of the EMB subgroups showed non-inferiority of VA or significantly fewer injections than the ranibizumab monotherapy arm. The secondary structural outcomes suggested that EMB was more effective in phakic eyes with good VA, and small classic or minimally classic lesions. However, none of the subgroups showed a significant difference between EMB and ranibizumab monotherapy


None of the predefined, year 1, subgroup analyses identified patients whose response to EMB was significantly better than ranibizumab monotherapy. Consequently, the data do not support the use of EMB in active, chronic neovascular AMD

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