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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.

BACKGROUND AND OBJECTIVE: To describe the 6-month safety and preliminary efficacy outcomes of the use of 16-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: A single treatment of a non-invasive, externally delivered low-voltage 16-Gy x-ray irradiation was administered in one session through three locations in the inferior pars plana. Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) examinations were performed at 1 week, 1 month, and monthly thereafter, with quarterly fluorescein angiography (FA). After the two initial ranibizumab injections, subsequent injections were administered according to the following criteria: VA decline of 10 ETDRS letters compared with baseline, increase of 100-μm central foveal thickness on OCT compared with baseline, the development of new submacular hemorrhage, and the development of a new area of classic choroidal neovascularization on FA. RESULTS: Twenty-six patients completed a 6-month follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 46.6 letters (range: 5 to 80; standard deviation [SD]: 21.5). At 6 months, the corresponding ETDRS score was 55.6 letters (range: 25 to 80; SD: 18.9) and the mean change in VA was 9.5 ETDRS letters (SD: 10.3). On responder analysis, 96% lost 15 or fewer ETDRS letters, 81% gained 0 or more ETDRS letters, and 50% gained 15 or more ETDRS letters. Patients received a total of 13 ranibizumab injections following two initial injections. At 6 months, patients received an average of 0.5 additional injections following the initial two mandated injections. CONCLUSION: A single treatment of externally applied, non-invasive 16-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement of VA in patients with neovascular AMD at 6 months with no radiation-related adverse effects.

* BACKGROUND AND OBJECTIVE: Corneal edema during penetrating keratoplasty (PK) precludes the visualization of the fundus required to perform vitreoretinal surgery. In this study, the clearing of the cornea and fundus visualization with dextran 40 following PK was evaluated. * PATIENTS AND METHODS: Topical dextran 40 was used in 12 eyes that underwent uncomplicated PK (phase 1) and in 5 eyes that underwent combined PK with vitreoretinal surgery (phase 2). * RESULTS: Clearing of the cornea and visualization of the fundus were observed in all eyes after dextran had been instilled for a mean of 4 and 5 minutes in eyes for phase 1 and 2, respectively. Vitreoretinal surgery could successfully be performed after PK in all eyes of phase 2. * CONCLUSION: Topical use of dextran 40 following PK produces enough clearing of the cornea to enable visualization of the fundus for further vitreoretinal procedures after the graft has been sutured. [Ophthalmic Surg Lasers 1998;29:980-984.]