RESUMO
BACKGROUND/AIMS: This study evaluated the short-term safety and feasibility of epiretinal strontium-90 brachytherapy delivered concomitantly with intravitreal bevacizumab for the treatment of subfoveal CNV due to AMD for 12 months. A 3-year follow-up is planned. METHODS: In this prospective, non-randomised, multicentre study, 34 treatment-naïve patients with predominantly classic, minimally classic and occult subfoveal CNV lesions received a single treatment with 24 Gy beta radiation (strontium-90) and two injections of the anti-VEGF antibody bevacizumab. Adverse events were observed. BCVA was measured using standard ETDRS vision charts. RESULTS: Twelve months after treatment, no radiation-associated adverse events were observed. In the intent-to-treat (ITT) population, 91% of patients lost <3 lines (15 ETDRS letters) of vision at 12 months, 68% improved or maintained their BCVA at 12 months, and 38% gained >/=3 lines. The mean change in BCVA observed at month 12 was a gain of 8.9 letters. CONCLUSION: The safety and efficacy of intraocular, epiretinal brachytherapy delivered concomitantly with anti-VEGF therapy for the treatment of subfoveal CNV secondary to AMD were promising in this small study population. Long-term safety will be assessed for 3 years. This regimen is being evaluated in a large, multicentre, phase III study.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Neovascularização de Coroide/radioterapia , Degeneração Macular/radioterapia , Compostos Radiofarmacêuticos/uso terapêutico , Radioisótopos de Estrôncio/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados , Bevacizumab , Braquiterapia/métodos , Neovascularização de Coroide/complicações , Neovascularização de Coroide/tratamento farmacológico , Terapia Combinada , Feminino , Humanos , Degeneração Macular/complicações , Degeneração Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Segurança , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade VisualRESUMO
PIP: A report of the World Health Organization's International Research Program for Human Reproduction states that worldwide demand for contraception has increased tenfold over the past 25 years. Some 380 million persons in developing countries today use modern and safe contraception, vs. only 31 million in 1960-65. The increase was most significant in East Asia, where there were 18 million users in 1960-65 and 217 million today and where 70% of couples have used a method. Population specialists expect a significant increase in demand amounting to over 100 million persons by the year 2000 as a result of the increased number of fertile-aged women. By 2000, nearly 560 million persons are projected to need contraception. The total fertility rate for developing countries has declined in the past two decades from 6.1 children per woman to 3.9 and is expected to drop to 3.3 by the year 2000. The contraceptive methods employed vary by country and level of development. Female sterilization is in first place in the poorest countries, followed by male sterilization and oral contraceptives and distantly by condoms, periodic abstinence, and withdrawal. Greater use of condoms in developed countries is due to the perception of threat from sexually transmitted diseases. The WHO estimates that 250 million sexually transmitted infections occur each year. An estimated 12 million persons are believed to be HIV positive. The use of OCs is relatively uncommon in China and India, which rely heavily on sterilization. The world fertility decline is believed to be due primarily to increased use of contraception, but abortion has played a role. The WHO estimates that between 36 and 53 million induced abortions occur each year, with 15 million of them illegal. 52 countries containing one-fourth of the world's population authorize abortion only to save the mother's life; 42 countries with 12% of the population permit abortion for medical or genetic reasons, rape, or incest; 13 countries with 23% of the population permit abortion for social or sociomedical reasons; and 25 countries with 40% do not require any specific reason. The authors of the report concluded that liberalized legislation does not necessarily imply higher rates of abortion.^ieng