Macular epiretinal brachytherapy in treated age-related macular degeneration: MERITAGE study: twelve-month safety and efficacy results

Ophthalmology. 2012 Jul;119(7):1425-31. doi: 10.1016/j.ophtha.2012.01.014. Epub 2012 Mar 30.


Purpose: To evaluate the safety and efficacy of epimacular brachytherapy (EMB) for the treatment of chronic, active, neovascular age-related macular degeneration (AMD).

Design: Prospective, multicenter, interventional, noncontrolled clinical trial.

Participants: Fifty-three eyes of 53 participants with neovascular AMD requiring frequent anti-vascular endothelial growth factor (VEGF) retreatment.

Methods: Participants underwent pars plana vitrectomy with a single 24-Gy dose of EMB delivered using an intraocular, handheld cannula containing a strontium 90/yttrium 90 source positioned over the active lesion. Participants were retreated with ranibizumab administered monthly as needed, using predefined retreatment criteria. Optical coherence tomography (OCT) was undertaken monthly, with images assessed by an independent reading center.

Main outcome measures: Coprimary outcomes at 12 months were proportion of participants with stable vision (losing <15 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and mean number of anti-VEGF retreatments.

Results: Before enrollment, participants had received an average of 12.5 anti-VEGF injections. After a single treatment with EMB, 81% maintained stable vision, with a mean of 3.49 anti-VEGF retreatments in 12 months. Mean ± standard deviation change in visual acuity was -4.0±15.1 ETDRS letters. Mean ± standard deviation OCT central retinal thickness increased by 50±179 μm. Common adverse events included conjunctival hemorrhage (n = 38), cataract (n = 16), resolving vitreous hemorrhage (n = 6), and eye pain (n = 5).

Conclusions: Epimacular brachytherapy produces stable visual acuity in most participants with previously treated, active disease. Epimacular brachytherapy may reduce the need for frequent anti-VEGF retreatment.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Brachytherapy*
  • Chronic Disease
  • Female
  • Fluorescein Angiography
  • Humans
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiotherapy Dosage
  • Ranibizumab
  • Retina / radiation effects
  • Strontium Radioisotopes / therapeutic use*
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity / physiology
  • Vitrectomy
  • Wet Macular Degeneration / drug therapy
  • Wet Macular Degeneration / physiopathology
  • Wet Macular Degeneration / radiotherapy*
  • Yttrium Radioisotopes / therapeutic use*


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Strontium Radioisotopes
  • Yttrium Radioisotopes
  • Ranibizumab