Adding epimacular brachytherapy to anti-VEGF treatment linked to worse visual acuity for neovascular ARMD

Adding epimacular brachytherapy (EMB) to anti–vascular endothelial growth factor treatment for neovascular age-related macular degeneration was associated with worse visual acuity compared with anti-VEGF treatment alone and did not reduce the number of ranibizumab injections needed, according to study results.

In the Macular Epiretinal Brachytherapy vs Ranibizumab (Lucentis) Only Treatment (MERLOT) pivotal device trial, 363 patients who had neovascular ARMD and received intravitreal ranibizumab were randomized 2:1 to receive EMB plus ranibizumab on an as-needed basis or just ranibizumab monotherapy on an as-needed basis. Follow-up lasted 24 months, with a final assessment at 36 months.

The mean (SD) number of ranibizumab injections was 9.3 (6.7) and 8.3 (4.5) in the EMB group and the ranibizumab group, respectively. Mean (SD) BCVA change was –11.2 (15.7) and –1.4 (10.9) ETDRS letters, respectively. Approximately 65% and 86% of participants lost fewer than 15 ETDRS letters in the EMB group and the ranibizumab group, respectively, with a difference of 21%. Microvascular abnormalities occurred in 9.7% of eyes in the EMB group and 1.0% of eyes in the ranibizumab group.

Reference

Jackson TL, Soare C, Petrarca C, et al. Evaluation of month-24 efficacy and safety of epimacular brachytherapy for previously treated neovascular age-related macular degeneration: The MERLOT Randomized Clinical Trial. JAMA Ophthalmol. Published online July 09, 2020. doi:10.1001/jamaophthalmol.2020.2309