One-year results from clinical practice of epimacular strontium-90 brachytherapy for the treatment of subfoveal choroidal neovascularization secondary to AMD

Ophthalmic Surg Lasers Imaging Retina. 2015 Mar;46(3):338-43. doi: 10.3928/23258160-20150323-07.


Background and objective: To evaluate clinical feasibility, safety, and efficacy of epiretinal strontium-90 brachytherapy in subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) in eyes unresponsive to repeated anti-VEGF injections.

Patients and methods: A retrospective, single-center study on patients treated with strontium-90 brachytherapy for CNV secondary to neovascular AMD. Patients underwent pars plana vitrectomy with a single 24 Gy dose brachytherapy. They were re-treated with anti-VEGF injections on an as-needed basis if subretinal or intraretinal fluid was detected on optical coherence tomography imaging.

Results: Twenty-two patients were treated, and 20 completed 12 months of follow-up. Ten patients maintained stable vision, eight gained vision, and two lost more than three Snellen lines. The mean best corrected visual acuity change from baseline was -8 ± 5.7 letters. A mean of 5.5 ± 4.4 anti-VEGF injections were administered throughout 12 months.

Conclusion: Epimacular brachytherapy is feasible in clinical practice. While some patients benefit from the treatment and need significantly fewer as-needed injections, others appear not to react to irradiation treatment after 1 year of follow-up. Larger numbers of patients are needed to evaluate therapeutic efficacy and to determine which patients can benefit from combined radiation and anti-VEGF therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use
  • Brachytherapy*
  • Choroidal Neovascularization / diagnosis
  • Choroidal Neovascularization / drug therapy
  • Choroidal Neovascularization / etiology
  • Choroidal Neovascularization / radiotherapy*
  • Combined Modality Therapy
  • Feasibility Studies
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Fovea Centralis
  • Humans
  • Male
  • Middle Aged
  • Radiotherapy Dosage
  • Retrospective Studies
  • Strontium Radioisotopes / therapeutic use*
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity
  • Vitrectomy
  • Wet Macular Degeneration / complications
  • Wet Macular Degeneration / diagnosis
  • Wet Macular Degeneration / drug therapy
  • Wet Macular Degeneration / radiotherapy*


  • Angiogenesis Inhibitors
  • Strontium Radioisotopes
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A