16-Gy low-voltage x-ray irradiation followed by as-needed ranibizumab therapy for AMD: 6-month outcomes of a "radiation-first" strategy.

Background and Objective: To describe the effect of a "radiation-first" combination treatment strategy for neovascular age-related macular degeneration (AMD) with ranibizumab rescue therapy.
Patients and Methods: Non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 16 Gy was given in a single session through three locations in the inferior pars plana in a consecutive series of patients with neovascular AMD. Ranibizumab was administered according to prospectively determined criteria.
Results: Thirteen patients completed a 6-month follow-up. All patients lost 15 or fewer ETDRS letters, 7 gained 0 or more ETDRS letters, and 0 gained more than 15 ETDRS letters. Patients received a total of 15 ranibizumab injections following x-ray irradiation at baseline. Two patients received no ranibizumab injections, seven patients received 1 injection, and four patients received 2 injections.
Conclusion: Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.
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