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Dr. Pravda Chaturvedi
Dr S N Medical College Jodhpur
 In Treatment of age related Macular
Degeneration Anti VEGF injections played
pivotal role since their discovery in mid
2000s.
 Earlier treatments merely slowed the on going
visual loss, whereas with Anti VEGF injections,
one could expect visual improvement.
 Frequent intra ocular injections
 Pain
 Inflammation
 Vitreous floaters
 Traumatic cataract
 Retinal detachment
 Geographic atrophy
 Systemic- slightly increased risk of stroke,
heart attack.
 Clue taken from oncology
 Uses a low energy X ray source
 X ray is collimated to a narrow beam
I. Enables rapid dose fall off
II. Precise targeting
III. Minimum radiation scatter
 During treatment, a vaccum coupled contact
are used to stabilise globe
 Real time monitoring done
 One year clinical trial, double blind
prospective study.
 230 patients of neovascular wet AMD * 3
years, already receiving anti VEGF injections.
 All received an initial dose of ranibizumab
and were randomised to receive 16Gy
radiation.
 Single 26 min radiotherapy treatment was
given.
 Patients were evaluated monthly *12months
 After 1 year- Injections were reduced by
1/3rd with comparable visual acuity. Then
patients were returned to their original
drug schedule
 After 2 years- Safety and efficacy data
were collected. Injections were reduced by
26%. Vision changes were similar.
 After 3 years- Only safety data were
collected. No significant difference visual
outcome.
 Radiation retinopathy- 33/122
18 regressed
14% wet amd
8% dry amd
 Radiations are anti-angiogenic, anti-
inflammatory, anti-proliferative.
 Doesn’t treat scar tissue.
 Eyes with actively proliferative leisons,
producing fluid leakage are more likely to
respond.
 Fibers grow centrifugaly, so fibers remain
proliferative at edges.
 Lesions with diameter <4mm, and/or macular
volume >7.4mm^3 reqired fewer injections.
 Radiation radiotherapy rare below 30 Gy.
 Develops within 7-36 months.
 Long term s/e like radiation radiotherapy and
microvasculopathy.
 Simultaneous clinical trial of s/e was
conducted.
 Over 3 yrs, 30 % patients receiving
radiations developed small localised
microvascular abnormality.
 It didn’t modify visual outcome
significantly.
 Few regressed themselves over time.
 Radiation exposure is 10% of CT Head &
same as dental radiography.
 Fractioning total dose reduces the risk
 Radiation retinopathy is now treatable by
Anti VEGF drugs.
 Most tolerated the treatment well and
were satisfied.
 Decreasing injections was most imp
cause.

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Oraya therapy.pptx1

  • 1. Dr. Pravda Chaturvedi Dr S N Medical College Jodhpur
  • 2.  In Treatment of age related Macular Degeneration Anti VEGF injections played pivotal role since their discovery in mid 2000s.  Earlier treatments merely slowed the on going visual loss, whereas with Anti VEGF injections, one could expect visual improvement.
  • 3.  Frequent intra ocular injections  Pain  Inflammation  Vitreous floaters  Traumatic cataract  Retinal detachment  Geographic atrophy  Systemic- slightly increased risk of stroke, heart attack.
  • 4.  Clue taken from oncology  Uses a low energy X ray source  X ray is collimated to a narrow beam I. Enables rapid dose fall off II. Precise targeting III. Minimum radiation scatter  During treatment, a vaccum coupled contact are used to stabilise globe  Real time monitoring done
  • 5.  One year clinical trial, double blind prospective study.  230 patients of neovascular wet AMD * 3 years, already receiving anti VEGF injections.  All received an initial dose of ranibizumab and were randomised to receive 16Gy radiation.  Single 26 min radiotherapy treatment was given.  Patients were evaluated monthly *12months
  • 6.  After 1 year- Injections were reduced by 1/3rd with comparable visual acuity. Then patients were returned to their original drug schedule  After 2 years- Safety and efficacy data were collected. Injections were reduced by 26%. Vision changes were similar.  After 3 years- Only safety data were collected. No significant difference visual outcome.  Radiation retinopathy- 33/122 18 regressed 14% wet amd 8% dry amd
  • 7.  Radiations are anti-angiogenic, anti- inflammatory, anti-proliferative.  Doesn’t treat scar tissue.  Eyes with actively proliferative leisons, producing fluid leakage are more likely to respond.  Fibers grow centrifugaly, so fibers remain proliferative at edges.  Lesions with diameter <4mm, and/or macular volume >7.4mm^3 reqired fewer injections.
  • 8.  Radiation radiotherapy rare below 30 Gy.  Develops within 7-36 months.  Long term s/e like radiation radiotherapy and microvasculopathy.  Simultaneous clinical trial of s/e was conducted.
  • 9.  Over 3 yrs, 30 % patients receiving radiations developed small localised microvascular abnormality.  It didn’t modify visual outcome significantly.  Few regressed themselves over time.  Radiation exposure is 10% of CT Head & same as dental radiography.  Fractioning total dose reduces the risk  Radiation retinopathy is now treatable by Anti VEGF drugs.
  • 10.  Most tolerated the treatment well and were satisfied.  Decreasing injections was most imp cause.