Stellungnahme der Retinologischen Gesellschaft, der Deutschen Ophthalmologischen Gesellschaft und des Berufsverbands der Augenärzte Deutschlands zur Strahlentherapie bei neovaskulärer altersabhängiger Makuladegeneration^[*]

In der Therapie der neovaskulären altersabhängigen Makuladegeneration (AMD) ist heute die intravitreale medikamentöse Therapie mit VEGF-Inhibitoren die Therapie der ersten Wahl [6]. Die entscheidende Verbesserung der Prognose der AMD wird allerdings durch viele intraokulare Injektionen und Untersuchungstermine und erhebliche Therapiekosten erkauft, sodass ein unvermindertes Interesse für alternative oder adjuvante Therapieformen in der Behandlung der AMD besteht. Die Strahlentherapie der neovaskulären AMD könnte dabei eine Option sein. Die potenziellen Bestrahlungstechniken und die aktuellen Ergebnisse sollen in dieser Stellungnahme dargestellt werden.

^* Dieser Beitrag wird ebenfalls in der Zeitschrift Der Ophthalmologe, Springer Verlag, Berlin Heidelberg 2015, veröffentlicht.

• Literatur

• Archer DB, Gardiner TA. Ionizing radiation and the retina. Curr Opin Ophthalmol 1994; 5: 59-65
• Balaiya S, Malyapa R, Hsi W. et al. Evaluation of proton beam radiation sensitivity of proliferating choroidal endothelial and retinal ganglion cells with clonogenic assay. Cutan Ocul Toxicol 2012; 31: 14-19
• Berson AM, Finger PT, Chakravarthy U. Radiation therapy for age-related macular degeneration. Semin Radiat Oncol 1999; 9: 155-162
• Chakravarthy U. Radiotherapy for choroidal neovascularisation of age-related macular degeneration: a fresh perspective. Eye (Lond) 2000; 14 (Pt 2) 151-154
• Chakravarthy U, Houston RF, Archer DB. Treatment of age-related subfoveal neovascular membranes by teletherapy: a pilot study. Br J Ophthalmol 1993; 77: 265-273
• Deutsche Ophthalmologische G. Die Anti-VEGF-Therapie bei der neovaskularen altersabhangigen Makuladegeneration – therapeutische Strategien: Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenarzte Deutschlands – November 2014. Ophthalmologe 2015; 112: 237-245
• Dugel PU, Bebchuk JD, Nau J. et al. Epimacular brachytherapy for neovascular age-related macular degeneration: a randomized, controlled trial (CABERNET). Ophthalmology 2013; 120: 317-327
• Evans JR, Sivagnanavel V, Chong V. Radiotherapy for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2010; 5: CD004004-CD004004
• Finger PT, Berson A, Ng T. et al. Ophthalmic plaque radiotherapy for age-related macular degeneration associated with subretinal neovascularization. Am J Ophthalmol 1999; 127: 170-177
• Finger PT, Gelman YP, Berson AM. et al. Palladium-103 plaque radiation therapy for macular degeneration: results of a 7 year study. Br J Ophthalmol 2003; 87: 1497-1503
• Gertner M, Chell E, Pan KH. et al. Stereotactic targeting and dose verification for age-related macular degeneration. Med Phys 2010; 37: 600-606
• Gunduz K, Shields CL, Shields JA. et al. Radiation retinopathy following plaque radiotherapy for posterior uveal melanoma. Arch Ophthalmol 1999; 117: 609-614
• Hart PM, Chakravarthy U, Mackenzie G. et al. Visual outcomes in the subfoveal radiotherapy study: a randomized controlled trial of teletherapy for age-related macular degeneration. Arch Ophthalmol 2002; 120: 1029-1038
• Hokkanen J, Heikkonen J, Holmberg P. Theoretical calculations of dose distributions for beta-ray eye applicators. Med Phys 1997; 24: 211-213
• Holmes SM, Micka JA, Dewerd LA. Investigation of a 90Sr/90Y source for intra-ocular treatment of wet age-related macular degeneration. Med Phys 2009; 36: 4370-4378
• Holz FG, Engenhart R, Bellmann C. et al. Stereotactic radiation therapy for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Front Radiat Ther Oncol 1997; 30: 238-246
• Jaakkola A, Heikkonen J, Tommila P. et al. Strontium plaque brachytherapy for exudative age-related macular degeneration: three-year results of a randomized study. Ophthalmology 2005; 112: 567-573
• Jaakkola A, Heikkonen J, Tommila P. et al. Strontium plaque irradiation of subfoveal neovascular membranes in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 1998; 236: 24-30
• Jackson TL, Chakravarthy U, Kaiser PK. et al. Stereotactic radiotherapy for neovascular age-related macular degeneration: 52-week safety and efficacy results of the INTREPID study. Ophthalmology 2013; 120: 1893-1900
• Jackson TL, Chakravarthy U, Slakter JS. et al. Stereotactic radiotherapy for neovascular age-related macular degeneration: year 2 results of the INTREPID study. Ophthalmology 2015; 122: 138-145
• Jackson TL, Dugel PU, Bebchuk JD. et al. Epimacular brachytherapy for neovascular age-related macular degeneration (CABERNET): fluorescein angiography and optical coherence tomography. Ophthalmology 2013; 120: 1597-1603
• Jackson TL, Shusterman EM, Arnoldussen M. et al. Stereotactic radiotherapy for wet age-related macular degeneration (INTREPID): influence of baseline characteristics on clinical response. Retina 2015; 35: 194-204
• Kirwan JF, Constable PH, Murdoch IE. et al. Beta irradiation: new uses for an old treatment: a review. Eye (Lond) 2003; 17: 207-215
• Kumar B, Palimar P. Accelerated radiation retinopathy in diabetes and pregnancy. Eye (Lond) 2000; 14 (Pt 1) 107-108
• Mauget-Faysse M, Coquard R, Francais-Maury C. et al. Radiothérapie dans la dégénérescence maculaire liée a lʼage: facteurs de risque de survenue des complications, prévention et traitement des effets secondaires. J Fr Ophtalmol 2000; 23: 127-136
• Moshfeghi DM, Kaiser PK, Gertner M. Stereotactic low-voltage x-ray irradiation for age-related macular degeneration. Br J Ophthalmol 2011; 95: 185-188
• Park SS, Daftari I, Phillips T. et al. Three-year follow-up of a pilot study of ranibizumab combined with proton beam irradiation as treatment for exudative age-related macular degeneration. Retina 2012; 32: 956-966
• Parsons JT, Bova FJ, Fitzgerald CR. et al. Radiation retinopathy after external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys 1994; 30: 765-773
• Saric B, Sikic J, Katusic D. et al. Brachytherapy – optional treatment for choroidal neovascularization secondary to age-related macular degeneration. Coll Antropol 2001; 25 (Suppl.) 89-96
• Schilling H, Sauerwein W, Friedrichs W. et al. Langzeitresultate der Strahlentherapie von Aderhauthämangiomen. Ophthalmologe 1996; 93: 154-157
• Scott TA, Augsburger JJ, Brady LW. et al. Low dose ocular irradiation for diffuse choroidal hemangiomas associated with bullous nonrhegmatogenous retinal detachment. Retina 1991; 11: 389-393
• Senan S, Smit EF. Design of clinical trials of radiation combined with antiangiogenic therapy. Oncologist 2007; 12: 465-477
• The Radiation Therapy for Age-Related Macular Degeneration (Rad) Study Group. A prospective, randomized, double-masked trial on radiation therapy for neovascular age-related macular degeneration (RAD Study). Radiation Therapy for Age-related Macular Degeneration. Ophthalmology 1999; 106: 2239-2247
• Timke C, Zieher H, Roth A. et al. Combination of vascular endothelial growth factor receptor/platelet-derived growth factor receptor inhibition markedly improves radiation tumor therapy. Clin Cancer Res 2008; 14: 2210-2219
• Zambarakji HJ, Lane AM, Ezra E. et al. Proton beam irradiation for neovascular age-related macular degeneration. Ophthalmology 2006; 113: 2012-2019