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Epimacular Brachytherapy for Previously Treated Neovascular Age-Related Macular Degeneration (MERLOT) A Phase 3 Randomized Controlled Trial

Lookup NU author(s): Professor David SteelORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Purpose: To assess the safety and efficacy of epimacular brachytherapy (EMB) for patients with chronic, active, neovascular age-related macular degeneration (AMD).Design: Phase 3 randomized controlled trial.Participants: Patients (n = 363) with neovascular AMD already receiving intravitreal ranibizumab injections. Intervention: Either pars plana vitrectomy with 24-gray EMB and ongoing pro re nata (PRN) ranibizumab (n = 224) or ongoing PRN ranibizumab monotherapy (n = 119).Main Outcome Measures: The coprimary outcomes, at 12 months, were the number of PRN ranibizumab injections and Early Treatment of Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (VA). Secondary outcomes included the proportion of participants losing fewer than 15 ETDRS letters, angiographic total lesion size, choroidal neovascularization (CNV) size, and optical coherence tomography (OCT) foveal thickness. A predefined subgroup analysis tested the influence of baseline ocular characteristics on the response to EMB.Results: The mean number of PRN ranibizumab injections was 4.8 in the EMB arm and 4.1 in the ranibizumab monotherapy arm (P = 0.068). The mean VA change was -4.8 letters in the EMB arm and -0.9 letters in the ranibizumab arm (95% confidence interval of difference between groups, -6.6 to -1.8 letters). The proportion of participants losing fewer than 15 letters was 84% in the EMB arm and 92% in the ranibizumab arm (P = 0.007). In the EMB arm, the mean total lesion size increased by 1.2 mm(2) versus 0.4 mm(2) in the ranibizumab arm (P = 0.27). The CNV size decreased by 0.5 mm(2) in the EMB arm and by 1.3 mm(2) in the ranibizumab arm (P = 0.27). The OCT foveal thickness decreased by 1.0 mm in the EMB arm and by 15.7 mm in the ranibizumab arm (P = 0.43). Most subgroups favored ranibizumab monotherapy, some significantly so. One participant showed retinal vascular abnormality attributed to radiation, but otherwise safety was acceptable.Conclusions: These results do not support the use of EMB for chronic, active, neovascular AMD. Safety is acceptable out to 12 months, but radiation retinopathy can occur later, so further follow-up is planned. Crown Copyright (C) 2016 Published by Elsevier Inc. on behalf of American Academy of Ophthalmology.

Publication metadata

Author(s): Jackson TL, Desai R, Simpson A, Neffendorf JE, Petrarca R, Smith K, Wittes J, Lewis C, Membrey L, Haynes R, Costen M, Steel DHW, Muldrew A, Chakravarthy U, Macular Epiretinal Brachytherapy V

Publication type: Article

Publication status: Published

Journal: Ophthalmology

Year: 2016

Volume: 123

Issue: 6

Pages: 1287-1296

Print publication date: 01/06/2016

Online publication date: 12/04/2016

Acceptance date: 12/02/2016

Date deposited: 09/08/2016

ISSN (print): 0161-6420

ISSN (electronic): 1549-4713

Publisher: Elsevier


DOI: 10.1016/j.ophtha.2016.02.028


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