Objective: To determine the efficacy of strontium plaque (Sr90) brachytherapy for age-related macular degeneration (AMD) with subfoveal choroidal neovascular ization (CNV). Design: Randomized clinical trial. Participa...Objective: To determine the efficacy of strontium plaque (Sr90) brachytherapy for age-related macular degeneration (AMD) with subfoveal choroidal neovascular ization (CNV). Design: Randomized clinical trial. Participants: Eighty-eight eyes of 86 patients with subfoveal CNV secondary to AMD were randomized either to plaque radiotherapy or to observation. Intervention: Radiotherapy was given as episcleral brachytherapy using Sr 90 plaques. Two different plaque types were used. Plaque I had a diameter of 8mm and delivered a dose of 15 Gy at a depth o f 1.75 mm in 54 minutes. With plaque II, the corresponding values were 4 mm, 12. 6 Gy, and 11 minutes. The control group was observed without any treatment. Main Outcome Measures: The primary outcome measure was visual acuity at 6, 12, 24, a nd 36 months. Other outcome variables were contrast sensitivity, fluorescein ang iographic, and clinically evaluated changes in the macula. Results: Eighty-two patients (84 eyes [95%]) completed the 1-year follow-up, and 80 (93%) and 74 (86%) patients completed the 2-and 3-year follow-ups, respectively. At 6 mo nths, visual loss of < 3 lines occurred in 20%of treated patients and 42%of co ntrol patients (P=0.031). At 12 months, a visual loss of < 3 lines occurred in 4 5%(treated) and 56%(controls) (P=0.325); at 24 months, in 73%and 71%(P=0.914 ); and at 36 months, in 80%and 84%of patients (P=0.591), respectively. Patient s irradiated with plaque I had better results: a visual loss of < 3 lines occurr ed in 6%at 6 months (P=0.008, relative to controls), in 18%at 12 months (P=0.0 07), in 59%at 24 months (P=0.348), and in 71%at 36 months (P=0.212). In patien ts treated with plaque II, the corresponding values were 29%(P=0.032), 65%(P=0 .459), 83%(P=0.317), and 80%(P=0.687) at 6, 12, 24, and 36 months, respectivel y. Conclusions: The short-term clinical course of exudativeAMD is affected by S r90 brachytherapy, but by 12 months, there was no treatment benefit.展开更多
Purpose To evaluate anterior and posterior segment complications and their man agement after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma. De sign Retrospective nonrandomized interventional study. Pa...Purpose To evaluate anterior and posterior segment complications and their man agement after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma. De sign Retrospective nonrandomized interventional study. Participants Ninety six patients with a large uveal melanoma according to the Collaborative Ocular Melan oma Study criteria. Methods The patients underwent primary IBT (median dose to t umor apex, 87 Gy). The median tumor height and diameter were 10.7 mm (range, 4.5 -16.8) and 16.5 mm (range, 7.3-25.0) , respectively, and the median follow up time was 3.5 years (range, 0.3-10.4). Cumulative incidence analysis and compet ing risks regression were used to analyze the time to individual complications a nd to identify risk factors. Death and secondary enucleation were analyzed as co mpeting risks. Main outcome measures Cataract, iris neovascularization, glaucoma , maculopathy, optic neuropathy, vitreous hemorrhage, and persistent exudative r etinal detachment (RD). Results The 5-year cumulative incidences of cataract, i ris neovascularization, and glaucoma were 69%(95%confidence interval [CI], 5 7 %-78%), 62%(95%CI, 50%-71%), and 60%(95%CI, 48%-70%), respectively. Posterior segment complications were less common. The 5-year incidences of mac ulopathy and optic neuropathy were 52%(95%CI, 35%-65%) and 46%(95%CI, 30 %-61%), and those of vitreous hemorrhage and persistent RD were 36%(95%CI, 23%-48%) and 25%(95%CI, 15%-36%), respectively. More than 80%of complic ations were diagnosed within 3 years. Cataract was the earliest complication to appear. Except for cataract, the cumulative incidence of dying without developin g a particular complication was 0.24 to 0.62 times that of first developing the complication. Increasing tumor height, which correlates to increasing doses to a djacent tissues, was associated with time to cataract (P=0.017), iris neovascula rization (P=0.087), and RD (P=0.046). Maculopathy and optic neuropathy were asso ciated primarily with distance to the fovea (P=0.015) and optic disc (P=0.015), respectively. Of 57 patients with cataract, 47%underwent cataract extraction, a nd 12%of 51 patients with glaucoma were treated with cyclophotocoagulation. The prevalence s of cataract, elevated intraocular pressure, and RD were 43%, 39%, and 13%, respectively, at 5 years. Conclusions The frequency with which ocular complicati ons develop after IBT is notably influenced by competing risks. Cumulative incid ence and prevalence analysis provide realistic estimates for patient counseling.展开更多
文摘Objective: To determine the efficacy of strontium plaque (Sr90) brachytherapy for age-related macular degeneration (AMD) with subfoveal choroidal neovascular ization (CNV). Design: Randomized clinical trial. Participants: Eighty-eight eyes of 86 patients with subfoveal CNV secondary to AMD were randomized either to plaque radiotherapy or to observation. Intervention: Radiotherapy was given as episcleral brachytherapy using Sr 90 plaques. Two different plaque types were used. Plaque I had a diameter of 8mm and delivered a dose of 15 Gy at a depth o f 1.75 mm in 54 minutes. With plaque II, the corresponding values were 4 mm, 12. 6 Gy, and 11 minutes. The control group was observed without any treatment. Main Outcome Measures: The primary outcome measure was visual acuity at 6, 12, 24, a nd 36 months. Other outcome variables were contrast sensitivity, fluorescein ang iographic, and clinically evaluated changes in the macula. Results: Eighty-two patients (84 eyes [95%]) completed the 1-year follow-up, and 80 (93%) and 74 (86%) patients completed the 2-and 3-year follow-ups, respectively. At 6 mo nths, visual loss of < 3 lines occurred in 20%of treated patients and 42%of co ntrol patients (P=0.031). At 12 months, a visual loss of < 3 lines occurred in 4 5%(treated) and 56%(controls) (P=0.325); at 24 months, in 73%and 71%(P=0.914 ); and at 36 months, in 80%and 84%of patients (P=0.591), respectively. Patient s irradiated with plaque I had better results: a visual loss of < 3 lines occurr ed in 6%at 6 months (P=0.008, relative to controls), in 18%at 12 months (P=0.0 07), in 59%at 24 months (P=0.348), and in 71%at 36 months (P=0.212). In patien ts treated with plaque II, the corresponding values were 29%(P=0.032), 65%(P=0 .459), 83%(P=0.317), and 80%(P=0.687) at 6, 12, 24, and 36 months, respectivel y. Conclusions: The short-term clinical course of exudativeAMD is affected by S r90 brachytherapy, but by 12 months, there was no treatment benefit.
文摘Purpose To evaluate anterior and posterior segment complications and their man agement after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma. De sign Retrospective nonrandomized interventional study. Participants Ninety six patients with a large uveal melanoma according to the Collaborative Ocular Melan oma Study criteria. Methods The patients underwent primary IBT (median dose to t umor apex, 87 Gy). The median tumor height and diameter were 10.7 mm (range, 4.5 -16.8) and 16.5 mm (range, 7.3-25.0) , respectively, and the median follow up time was 3.5 years (range, 0.3-10.4). Cumulative incidence analysis and compet ing risks regression were used to analyze the time to individual complications a nd to identify risk factors. Death and secondary enucleation were analyzed as co mpeting risks. Main outcome measures Cataract, iris neovascularization, glaucoma , maculopathy, optic neuropathy, vitreous hemorrhage, and persistent exudative r etinal detachment (RD). Results The 5-year cumulative incidences of cataract, i ris neovascularization, and glaucoma were 69%(95%confidence interval [CI], 5 7 %-78%), 62%(95%CI, 50%-71%), and 60%(95%CI, 48%-70%), respectively. Posterior segment complications were less common. The 5-year incidences of mac ulopathy and optic neuropathy were 52%(95%CI, 35%-65%) and 46%(95%CI, 30 %-61%), and those of vitreous hemorrhage and persistent RD were 36%(95%CI, 23%-48%) and 25%(95%CI, 15%-36%), respectively. More than 80%of complic ations were diagnosed within 3 years. Cataract was the earliest complication to appear. Except for cataract, the cumulative incidence of dying without developin g a particular complication was 0.24 to 0.62 times that of first developing the complication. Increasing tumor height, which correlates to increasing doses to a djacent tissues, was associated with time to cataract (P=0.017), iris neovascula rization (P=0.087), and RD (P=0.046). Maculopathy and optic neuropathy were asso ciated primarily with distance to the fovea (P=0.015) and optic disc (P=0.015), respectively. Of 57 patients with cataract, 47%underwent cataract extraction, a nd 12%of 51 patients with glaucoma were treated with cyclophotocoagulation. The prevalence s of cataract, elevated intraocular pressure, and RD were 43%, 39%, and 13%, respectively, at 5 years. Conclusions The frequency with which ocular complicati ons develop after IBT is notably influenced by competing risks. Cumulative incid ence and prevalence analysis provide realistic estimates for patient counseling.
