Emerging treatments
Stereotactic radiotherapy
Low-voltage, external-beam, stereotactic radiotherapy has been reported to reduce the number of re-treatments required for neovascular AMD with ranibizumab.[107] One randomised, double-masked, sham-controlled trial found that stereotactic radiotherapy significantly reduced the number of intravitreal ranibizumab injections required compared with sham radiotherapy over a 2-year period.[108] One Cochrane review has concluded that the benefits of currently available radiotherapy options is uncertain.[109]
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Ranibizumab ocular implant
The ranibizumab ocular implant is a drug delivery system for the continuous intravitreal delivery of a customised formulation of ranibizumab. The ocular implant consists of a reservoir which is implanted surgically into the eye, in which a specific formulation of ranibizumab may be injected periodically (refilled) in an office setting, as required, based on disease activity.[110] One randomised phase 3 trial found that the ranibizumab ocular implant was non-inferior and equivalent to monthly intravitreal ranibizumab injections in terms of change in best-corrected visual acuity at an average of 36 and 40 weeks from baseline.[111] The Food and Drug Administration (FDA) has approved the ranibizumab ocular implant for the treatment of patients with neovascular AMD who have previously responded to at least two intravitreal vascular endothelial growth factor (VEGF) inhibitor injections. The ranibizumab implant has been associated with increased risk of endophthalmitis compared with monthly intravitreal ranibizumab injections.[4] The ranibizumab ocular implant has not been approved in Europe.
Photobiomodulation
One double-masked, multi-centre, randomised clinical trial compared photobiomodulation with sham treatment in patients with early or intermediate non-exudative AMD over 13 months.[112] The results showed a significantly greater improvement in best-corrected visual acuity in the photobiomodulation group compared with the sham treatment group. The FDA has approved one device for photobiomodulation in patients with dry AMD.[4]
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