THE SURGICAL REMOVAL OF SUBFOVEAL CHOROIDAL NEOVASCULARIZATION - INGROWTH SITE AS A PREDICTOR OF VISUAL OUTCOME

Purpose: The authors determine the significance of location of the ing rowth site of subfoveal choroidal neovascularization (CNV) as a preope rative indicator of postsurgical visual acuity. Design: A retrospectiv e review is given of preoperative fluorescein angiograms and color fun dus photographs for 84 eyes with subfoveal CNV due to the following et iologies: presumed ocular histoplasmosis syndrome (POHS) = 67 eyes; mu ltifocal choroiditis = 9 eyes; idiopathic = 8 eyes. The ingrowth site of the subfoveal CNV was classified as identifiable or not identifiabl e. If identifiable, the ingrowth site was further classified as extraf oveal, juxtafoveal, or subfoveal. Correlations between CNV ingrowth si te location and postoperative visual acuity were made. Results: The in growth site for subfoveal CNV was identifiable preoperatively in 60 ey es (71%). Of 31 eyes with an extrafoveal ingrowth site, 18 (60%) had a final visual acuity of 20/40 or better. Of 12 eyes with a juxtafoveal ingrowth site and 18 eyes with a subfoveal ingrowth site, only 2 (7%) had a final visual acuity of 20/40 or better. If the ingrowth site wa s not identifiable or identifiable and subfoveal in location (N = 42), 76% of eyes had a final visual acuity of 20/200 or worse. Conclusion: The ingrowth site of subfoveal CNV can be identified in the majority of eyes with POHS, multifocal choroiditis, or idiopathic membranes. A significant number of subfoveal CNV will have an extrafoveal ingrowth site. Eyes with an extrafoveal ingrowth site have a favorable visual p rognosis after the surgical removal of the CNV. If the ingrowth site i s subfoveal or not identifiable, the visual prognosis after surgery is guarded.